Name:
Phone:
Email:

Date you would like enrollment to start: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / January February March April May June July August September October November December
Desired enrollment date unknown

Class:
Cuddle Bug (6 weeks to 18 months)
Yellow Bee (18 months to 30 months)
Green Gecko (2.5 years to 3.5-4 years,fully toilet trained)
Orange Giraffe (4 years to kindergarten)

Schedule:
Half-Day (8:15am-12:15pm)
Full-Day (Maximum of 10 hours of care between 6:30am-5:30pm)
Cuddle Bug (Maximum of 10 hours of care 6:30am-5:00pm)


Active Military: Yes No

YMCA/CDA Qualified: Yes No

Additional Comments
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