Kindergarten Readiness Program Registration

Kindergarten Readiness Program - Application for Enrollment
Please fill out the form below and someone will be in touch with you as soon as possible.
25 Joy Drive
South Burlington, VT 05495
802-658-0080
4 Morse Drive
Essex Junction, VT 05452
802-879-7734 x1113
Today's Date
MM slash DD slash YYYY
Child's Name*
Date of Birth*
MM slash DD slash YYYY

*Child must be 3 by 9/1/15
Address
Street Address Address Line 2 City State ZIP Code
Proposed Start Date
Requested Days - First Choice
- Monday/Wednesday
- Tuesday/Thursday
Add a paid Friday at $45/week
- Yes, please.
Location 1st Choice
Location 2nd Choice
Parent/Guardian Contact info
Parent Guardian Name*
Parent/Guardian Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Work Phone
Cell Phone
Email*
Is your child fully potty trained?
- Yes
- No
Has your child ever been enrolled in childcare or preschool before?
- Yes
- No
Does your child have any special needs we should be aware of?
How did you hear about us?