Pre-registration Form

 

 

 

 

 

 

 

 

Child’s Name:______________________________________________Birthdate:______________________________

 

 

 

 

 

 

Child’s Name:______________________________________________Birthdate:______________________________

 

 

 

 

 

 

Address:_____________________________________  City:__________________________, KY  Zip:_______________

 

 

 

 

 

 

Requested Start Date:______________________________________________________

 

 

 

 

 

 

Needed attendance:       M       T        W        Th        F            Hours Needed:_____________________________

 

 

 

 

 

 

Were you referred by a friend?  YES       NO         Whom?______________________________________________

 

 

 

 

 

 

Mother’s Name:___________________________________________Cell:_____________________________________

 

 

 

 

 

 

Father’s Name:____________________________________________Cell:_____________________________________

 

 

 

 

 

                                                                                                                                

 PAID on ______________________

 

 

 

Registration is FREE, Upon securing your spot we do charge $50 enrollment fee.

This is always changing so please feel free to contact us for more info. Print out this pre-registration form, complete it and mail or drop it off and we will respond at our earliest convenience.