Registration
Preschool Parents Day Out
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone:* Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Any allergies or additional information we should know of?
Who will be picking up your child? (ID required)*
By answering yes, I am confirming that I will be providing my child with a snack, lunch, and water.*
There will be no refunds for any reason. By enrolling in this Preschool Camp, you are confirming that you have read and understand our no refunds policy.*
 
Additional Information:
 
Release of Liability
  (Show-Hide Details)
I've read the above and agree.
 
No Refunds
  (Show-Hide Details)
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*