Pre-Registration Form

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Child's Information
MM/DD/YYYY
Gender:  (required)
Is child Potty Trained?  (required)
Parent/Guardian Information
The following questions will help to determine which of our high-quality programs will best serve your family’s needs.
Marital Status:  (required)
Child lives with: (check all that apply)  (required)
Help for Names and ages of children in household/school each child attends: (If none, enter n/a) Please include the names and ages of all children in the household.
Income Source:  (required)
Will your child need Before/After School Latchkey services?  (required)
Is there any additional information you can share about your child/family? (Check all that apply)
Is there any additional Information that you can share about your child/family? (check all that apply)  (required)
Security Check - To verify you are not a robot, please answer this question: