Student Registration Form New Student Registration FormChild’s Name*Date of Birth (MM/DD/YYYY)*Gender*MaleFemaleParent/Guardian’s Name*Address* Street Address City ZIP / Postal Code Home PhoneWork PhoneCell Phone*E-mail Address* Please check the program that most fits your needsPlease select the program:*ToddlerPreschoolElementaryPlease choose the schedule:* Please note 5 full days only for Elementary students 3 half days (9:00am – 12:00pm)5 half days (9:00am – 12:00pm)3 full days (9:00am – 3:00pm)5 full days (9:00am – 3:00pm)Days attending each week:* Monday Tuesday Wednesday Thursday Friday Extended day care?*YesNoChoose extended care*am daycare (7:00am - 9:00am)pm daycare (3:00pm - 6:00pm)am & pm daycare (7:00am - 9:00am & 3:00pm - 6:00pm)Parent Signature*Date* Date Format: MM slash DD slash YYYY Parent SignatureDate Date Format: MM slash DD slash YYYY Required FeesNew Student Registration FeeEarthquake Kit