Skip to content

Fancy cap - EEarly Childhood Learning Waiting List

Fill out the form to pre-register for your class(es). Actual class registration is not confirmed until payment is received. All waiting list applications must be accompanied by a nonrefundable deposit of $250.00.

Please fill out one application for each student and class.

Child's Full Name:
Gender: F    M
Date of Birth: (mm/dd/yyyy)
Complete information for at least one parent or guardian is required to process your application.
Parent/Guardian:
Address:
City:
State:   Zip:
Home Phone:
Work Phone:
Cell Phone/Pager:
Email:
Occupation/Employer:
 
Parent/Guardian:
Address:
City:
State:   Zip:
Home Phone:
Work Phone:
Cell Phone/Pager:
Email:
Occupation/Employer:
Date you hope to begin attending: (mm/dd/yyyy)
Preferred Location :