School Year Enrollment Form

Please fill out the following form to enroll your child in our School Year Enrollment program, which serves infants, toddlers, preschool, and pre-k, as well as grade schoolers K-5. Our program includes a variety of fun and educational activities, such as musical plays and sing-alongs, arts and crafts, outside games, field trips, presentations, and a “Learning Bridge” component focused on math and literacy skills.

For grade schoolers K-5, we also offer before and after school care, providing a safe and nurturing environment for your child outside of regular school hours.

Enrolling your child in our program will give them the opportunity to make new friends, learn new skills, and have a blast throughout the school year! To reserve your child’s spot, please fill out all required fields and submit the form as soon as possible.

Thank you for choosing our program for your child’s enrichment and enjoyment!

Parent / Guardian Information

Primary Parent Name(Required)

First Last

Primary Parent Contact Cell(Required)

Primary Parent Contact Work(Required)

Primary Parent Email(Required)

Enter Email Confirm Email

Primary Parent Address(Required)

Street Address Address Line 2 City State ZIP Code

Secondary Parent

Secondary Parent Name(Required)

Full Name

Secondary Parent Contact Cell(Required)

Secondary Parent Contact Work(Required)

Secondary Parent Email(Required)

Enter Email Confirm Email

Secondary Parent Address(Required)

Street Address Address Line 2 City State ZIP Code

Guardian Information

Guardian Name(Required)

Full Name

Guardian Contact Cell(Required)

Guardian Contact Work(Required)

Guardian Email(Required)

Enter Email Confirm Email

Emergency Contact

In the event of an emergency involving your child, we will contact the emergency contact person listed below. It is important that you provide accurate and up-to-date information to ensure that we can reach the designated person as quickly as possible.

Emergency Contact 1 Name(Required)

Emergency Contact 1 Phone(Required)

Emergency Contact 2 Name(Required)

Emergency Contact 2 Phone(Required)

Emergency Contact 3 Name

Emergency Contact 3 Phone

Emergency Contact 4 Name

Emergency Contact 4 Phone

Child Information

Child's Name(Required)

First Last

Date of Birth(Required)

Allergies

Education Station Class List(Required)

Grade(Required)

Week Schedule(Required)

Please be sure to select a minimum of two days.

Monday

Tuesday

Wednesday

Thursday

Friday

Scheduled Hours(Required)

Enter Mixed Schedule Below(Required)

Drop Off(Required)

Please specify drop-off time (7:00 AM - 1:00 PM, Mon-Fri). Contact us for exceptions.

Pickup(Required)

Specify pickup time (12:00 PM - 6:00 PM, Mon-Fri). Late pickups should be arranged in advance.

Child 2 Information

Child's Full Name(Required)

First Last

Date of Birth(Required)

Allergies

Education Station Class List(Required)

Grade(Required)

Child 2 Week Schedule(Required)

Please be sure to select a minimum of two days.

Monday

Tuesday

Wednesday

Thursday

Friday

Child 2 - Scheduled Hours(Required)

Enter Mixed Schedule Below(Required)

Drop Off(Required)

Please specify drop-off time (7:00 AM - 1:00 PM, Mon-Fri). Contact us for exceptions.

Pickup(Required)

Specify pickup time (12:00 PM - 6:00 PM, Mon-Fri). Late pickups should be arranged in advance.

Child 3 Information

Child's Full Name(Required)

First Last

Date of Birth(Required)

Allergies

Education Station Class List(Required)

Grade(Required)

Child 3 Week Schedule(Required)

Please be sure to select a minimum of two days.

Monday

Tuesday

Wednesday

Thursday

Friday

Child 3 - Scheduled Hours(Required)

Enter Mixed Schedule Below(Required)

Drop Off(Required)

Please specify drop-off time (7:00 AM - 1:00 PM, Mon-Fri). Contact us for exceptions.

Pickup(Required)

Specify pickup time (12:00 PM - 6:00 PM, Mon-Fri). Late pickups should be arranged in advance.

Child 4 Information

Child's Full Name(Required)

First Last

Date of Birth(Required)

Allergies

Education Station Class List(Required)

Grade(Required)

Child 4 Week Schedule(Required)

Please be sure to select a minimum of two days.

Monday

Tuesday

Wednesday

Thursday

Friday

Child 4 - Scheduled Hours(Required)

Enter Mixed Schedule Below(Required)

Drop Off(Required)

Please specify drop-off time (7:00 AM - 1:00 PM, Mon-Fri). Contact us for exceptions.

Pickup(Required)

Specify pickup time (12:00 PM - 6:00 PM, Mon-Fri). Late pickups should be arranged in advance.

Payment Options

We understand that paying for daycare fees can be stressful, which is why we offer several payment options for your convenience. You can make payments in person by check or cash, or online by credit card. Please note that a convenience fee of $1.36 will be added to all credit card payments.

To make a payment online by credit card, please select the credit card option below and follow the instructions provided. We accept all major credit cards, including Visa, Mastercard, and American Express. If you prefer to make a payment in person, please stop by our office during business hours to pay by check or cash. In addition to payment information, please note that our enrollment form collects information such as parent/guardian information, emergency contact information, and drop-off and pick-up schedule. This information is necessary for us to provide quality care for your child. We want to assure you that all information collected through the enrollment form is confidential and used solely for the purpose of providing childcare services. We will not share your personal information with any third parties, unless required by law. If you have any questions or concerns regarding payment options, the convenience fee, or our enrollment form, please do not hesitate to contact us. We are here to help and want to make the payment and enrollment process as easy and convenient as possible for you. Thank you for entrusting us with the care of your child, and we look forward to continuing to serve you.

Payment Method(Required)

Pay in person by check, cash, and credit card. Pay online by credit card (convenience fee of $1.36 added) If you have any questions or concerns about payment options, please contact us.

One-Time Enrollment Fee (Required)

Please note that there is a one-time enrollment fee of $55 per child. This fee helps to cover the administrative costs associated with enrolling your child in our program, including processing paperwork and maintaining records. The enrollment fee is non-refundable and is due at the time of enrollment. We appreciate your understanding and support of our program.

Price: $56.95

Total

Credit Card(Required)

Please create a Square feed.

Please verify your card number and expiration date prior to submission.

Phone

This field is for validation purposes and should be left unchanged.