Name *

First Name

Last Name

Phone

(###)

###

####

Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Days of Attendance *

Please take note of age requirements for each attendance option: Caterpillar Class: 3-day Must be 2.5 years old by September 1st Chrysalis Class: 4-day Must be 3 years old by September 1st Butterfly Class: 5-day Must be 4 years old by September 1st Please select the correct option for your child:

Caterpillar: 3-day

Chrysalis: 4-day

Butterfly: 5-day