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Child Name
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Birthdate/Due Date
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Male Female |
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Street Address
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City
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State
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Zip |
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Home Phone
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Email Address
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Mother's Name
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Mother Bus.Phone/Cell Phone
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Father's Name
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Father Bus.Phone/Cell Phone
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Child Lives With
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When are you hoping
to enroll your child?
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Are you looking for:
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Full Time Part Time |
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If Part-time - What days would
your child attend?
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Monday
Tuesday
Wednesday
Thursday
Friday
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Approximate drop-off time
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Pick-up time
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Please select the programs you're interested in:
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Full Day Programs
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Infants (5 full days only)
Older Infants (2-5 full days)
Toddlers (2-5 full days)
Preschool 3's (2-5 full days)
Preschool 4's (2-5 full days)
Kindergarten w/wrap around child care
Elementary w/before & after school care Please specify grade (1-6)
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Class Only Programs
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SWAP Preschool 3's - T/Th AM 8:45-11:30 PM 12:30-3:00
SWAP Preschool 4's - M/W/F from 9am - 2pm
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Additional Programs
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Before/After School Program Before After Both
Holiday/Vacation/Snow Day Program (Grades 1-6)
Summer Camp Program (Grades K-7)
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How did you hear about us?
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Comments/Questions
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