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Tuition rates for the 2015-2016 school year:

• $35 per Family - non-refundable registration fee
• 5 Day Program - $285 per month/per child
• 3 Day Program - $185 per month/per child
• 9 Payments - due on the 15th of each month
• 10% Discount - on two enrolled children
• 15% discount - on three or more enrolled children

Parent/Guardian Signature *
Parent/Guardian Signature
Pediatrician *
Pediatrician
Pediatrician Phone *
Pediatrician Phone
Father's Name *
Father's Name
Mother's Name
Mother's Name
Address *
Address
Home Phone
Home Phone
Mobile Phone
Mobile Phone
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact Phone *
Emergency Contact Phone
Emergency Contact 2
Emergency Contact 2
Emergency Contact Phone 2
Emergency Contact Phone 2
First Child *
First Child
Birthdate *
Birthdate
Program Days *
What days are you looking to enroll your child?
If your child has allergies, please list them here:
Second Child
Second Child
Birthdate
Birthdate
Program Days
Third Child
Third Child
Birthdate
Birthdate
Program Days