Start here with this form so we can put your child into our computer. Additional state of California enrollment forms must be completed before they can start.

Child's Name

First Name

Last Name

Sex of Child

Male

Female

Not born yet

Child's Birthdate (Or Due Date)

YYYY

Child's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent A

Name of financially responsible parent

First Name

Last Name

Parent A's Mobile Phone

Cell Phone of Parent A

(###)

###

####

Parent A's Email

Email of Parent A

Parent B

Add name if they can pick up child

First Name

Last Name

Parent B's Mobile Phone

Add cell phone if they can pick up child

(###)

###

####

Parent B's Email

Add email if they can pick up child

Physician to call in emergency

Put "Call 911" If no physician

Physician's Phone

(###)

###

####

What days of the week will child attend?

What time will child be dropped off and picked up?

Any questions or comments for us?