Tots Program Applicant Information

Applying for academic year *

Child First Name *

Child Middle Name

Child Last Name *

Prefers to be called

Date of Birth +

Gender *

Male

Female

Street Address *

Address Line 2

City *

State *

Zip Code *

Primary Phone *

Please rank your top three preferred day(s) of attendance: *

	1 day/week - Tuesday
	1 day/week - Wednesday
	1 day/week - Thursday
	2 days/week - Tuesday/Wednesday
	2 days/week - Wednesday/Thursday
	2 days/week - Tuesday/Thursday

Ongoing applications will receive confirmation as they are received. Each class is limited to 10 students. A minimum of 5 children must be registered in a class in order for it to run.