CHILD'S INFORMATION

*Name:

*Current Age:

*Birth Date:

*Sex: F M

*Start Date:

*Age When Starting:

MOTHER'S INFORMATION

*Name:

*Home Phone:

*Cell Phone:

*Work Phone:

*Email:

Address:

City:

Zip Code:

FATHER'S INFORMATION

*Name:

*Home Phone:

*Cell Phone:

*Work Phone:

*Email:

Address:

City:

Zip Code:

PREFERRED SCHEDULE AND DAYS YOU WOULD LIKE TO ATTEND

*DAYS: Monday Tuesday Wednesday Thursday Friday

*Preferred Enrollment - Full Year September through June

TODDLER

*Half Days - 3 Half Days 8:30-12:30 4 Half Days 8:30-12:30 5 Half Days 8:30-12:30

*Full Days - 3 Full Days 9:00-3:00 4 Full Days 9:00-3:00 5 Full Days 9:00-3:00

*Extended Days - 3 Extended Days 7:30-5:00 4 Extended Days 7:30-5:00 5 Extended Days 7:30-5:00

PRESCHOOL (3yrs and up and potty trained)

*Half Days - 2 Extended Days 7:30-5:00 3 Extended Days 7:30-5:00 4 Extended Days 7:30-5:00 5 Extended Days 7:30-5:00

*Full Days - 3 Full Days 9:00-3:00 4 Full Days 9:00-3:00 5 Full Days 9:00-3:00

*Extended Days - 3 Extended Days 7:30-5:30 4 Extended Days 7:30-5:30 5 Extended Days 7:30-5:30

How Did You Hear About TBCC?

*Required