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Program Registration
Please fill out this form to register for our program.
Parent/Guardian First name
*
Parent/Guardian Last name
*
Phone number
*
Email address
*
Child's First & Last Name
*
Child's Date of Birth
*
Month
Day
Year
Tell us a little about your child. What do they enjoy, what is their personality like, and what helps them feel comfortable in a new environment, etc.?
*
Is there anything else we should know about your child? Please include any allergies, medical/ dietary needs, developmental or behavioral considerations, communication needs, or other information that may help us care for your child.
*
What language(s) does your child currently speak or understand?
*
English
Russian
Spanish
Other
Is your child currently toilet trained?
*
Yes, independently
Mostly / still needs occasional assistance
Currently toilet training
Not yet
What is your child's current childcare experience?
*
Preferred schedule
*
5 Days / Full-Time
3 Days (Mon, Wed, Fri)
2 Days (Tues, Thurs)
Desired Start Date
*
What are you looking for in a childcare program for your child?
*
How did you hear about us?
*
Submit Application
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