2011-2012 Preschool and Kindergarten School Year Registration Request Form

Please make sure that you have already enrolled in the center. The program also requires a non-refundable supply fee of $125. 


Student's Name                                                                        DOB                                     Age

First day attending

Will you be paying in monthly installments?                                   

Will you be paying in full?







Any concerns and/or goals?





Please Note: Class confirmation will not be made until all fees are paid.

Signature

E-mail

Referred by





CREDIT CARD AUTHORIZATION

Name on Card

Type of Card

Card Number

Expiration Date 

By submitting this form, I agree to have Wild About Learning charge my credit card for the following charges:



CLASSES START September 6, 2011
Can Start Anytime
Enrollment and Registration Fee  of $165
Registration Fee of $125 (currently enrolled)
T/TH Half Day 9-12 option
T/TH Full Day 9-2:30 option
Tuesday only Full Day 9-2:30 option
Thursday only Full Day 9-2:30 option
Tuesday only Half Day 9-12 option
Thursday only Half Day 9-12 option