Parent Name(s)   Phone Numbers   Home       Other                  Email                Address   Child's Name         Age   Birth Date            Program Needs  (please check all areas of interest)    Half Day (8:30 - 11:45)     Half Day + Lunch (8:30 - 12:30)            Full Day with Nap  (8:30 - 3:00)     Full Day Academic (8:30 - 3:00)  child must be 4 by Sept 1st      Early Bird (7:30 - 8:30)     Extended Day (3:00 - 6:00)   Summer Camp Interested Start Date   How did you hear about us? Special Comments/Notes:   Thank you for your interest.  We will be in touch shortly.

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