Bilingual 3 Year Old Program – Full day – 5 days – $1150

Course Price: $1,150.00

Student's Info
Name * Required
First Last
Age * Required
Birth Date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Sex * Required
- Male
- Female
Grade Entering * Required
School * Required
Address * Required
Street Address City ZIP Code
Parent/Guardian Contact #1 Info
Name * Required
First Last
Relationship to student * Required
Mobile Phone Number * Required
Home Phone Number * Required
Email * Required
Parent/Guardian Contact #2 Info
Name * Required
First Last
Relationship to student * Required
Mobile Phone Number * Required
Home Phone Number * Required
Email * Required
Emergency Information during program hours & authorized people to pick up child:
Relationship * Required
Contact #1 Phone Number * Required
Pick Up? * Required
- Yes
- No
Relationship * Required
Contact #2 Phone Number * Required
Pick Up? * Required
- Yes
- No
Please note any recent/current illness/injury or existing medical conditions:
Allergies? * Required
- Yes
- No
If Yes, please explain:
Prescription RX?
Were you referred by anybody?

Class ID: 4836 Category: Classes

Student's Info