Please complete this form and return with the non-refundable registration fee of $60.00.
Annual tuition can be paid in ten equal installments starting August 1st through May 1st.
Child’s Name: ______Date of Birth ______
Parent #1: / Parent #2:First Name / Last Name / First Name / Last Name
Address / Address
City / State, Zip / City / State, Zip
Home Phone / Home Phone
Cell Phone / Cell Phone
Work Phone / Work Phone
Email Address (required for invoices and newsletters) / Email Address
------Please check which program your child will be attending:
Tuesday / Thursday / 2.9 – 4 year olds / 9:00 a.m. – 12:00 p.m. / $1950Tuesday / Thursday / 2.9 – 4 year olds / 9:00 a.m. – 2:30 p.m. / $3240
Monday / Wednesday / Friday / 3.8 – 5 year olds / 9:00 a.m. – 12:00 p.m. / $2370
Monday / Wednesday / Friday / 3.8 – 5 year olds / 9:00 a.m. – 2:30 p.m. / $4470
When registering for the full-day program, please indicate your preference below regarding classroom placement.
We will make every effort to accommodate your request, but final placement is dependent on enrollment and staffing.
____ I would prefer my child remain with at least one familiar teacher all day (if at all possible), even if that means traveling to the other classroom for the second half of the day.
____ I would prefer my child remain in the same physical space all day (if at all possible), even if that means having a different teacher for the second half of the day.
____ I have no preference.
PLEASE WRITE THE NAME OF THE PERSON WHO REFERRED YOU TO PUCKIHUDDLE SO WE CAN THANK THEM!
______
FOR OFFICE USE ONLY: Start Date ______Prorated Tuition ______Discount (%) ______