Monthly Registration

Monthly Registration Form

Must fill out a form for each child if you are registering more than one child.

Childs Name

First Name*

Last Name*

Parent Name

First Name*

Last Name*

E-mail

Required*

Phone

Required* --

School

Please provide school your child attends*

Grade

Required*

Select Month or Break you are registering for

Required*

Which type of care
Required*

	Before Care
	Aftercare
	Full Day Care
	Fall Break
	Spring Break

Please input the days you need for the month you are registering for

Required*

You can write like this: 2/1, 4, 6, 8, or All Days or Week of ?. You can also do Before Care 2/1, 2, 3.... Aftercare 2/1,5, 6, 7.... Full Day 2/8, 9, ...

Message

Important

PAYMENT MUST BE IN FULL by the 1st of the month. Please make a copy of your registration form. Your canceled check is your receipt. We will do payment arrangements on a case by case basis. Receive a 10% discount on your total if paid in full by the 21st of the month.

Monthly Registration

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