Fall 2018 Learning Together Class for Parents and Children 12-24 months Registration Request Form

Complete and submit this form to apply for enrollment in our class for parents and children 12-24 months. In this class, you and your child will explore developmental activities, learn songs and rhymes and discover new skills and strategies to stimulate growth and development in your toddler. The class is 9 weeks long and runs on Mondays or Tuesdays, starting the week of September 10 through November 5. The cost is $108 for the entire session. Cash or checks (payable to RBCPC Preschool) are accepted.

Currently as of 5/18/18 ALL CLASSES listed below are full.

We are ONLY accepting waitlist names.

If you would like to be added to the WAITLIST for any of the classes please

complete the form below with you preferences.

We will call immediately if changes occur and we are able to offer you a space.

Child's First Name *

Child's Last Name *

What is your first choice for a class time? *

WL - Monday's 10:30-11:30 am

WL - Tuesday's 9am - 10 am

WL - Tuesday's 10:30 - 11:30 am

What is your second choice for a class time? *

WL -Monday's 10:30-11:30 am

WL -Tuesday's 9am - 10 am

WL - Tuesday's 10:30 - 11:30 am

What is your third choice for a class time? *

WL - Monday's 10:30-11:30 am

WL - Tuesday's 9am - 10 am

WL - Tuesday's 10:30 - 11:30 am

Child's Gender *

Male

Female

Your Child's birth date: Month/Day/Year *

Parent #1/Guardian #1 First Name *

Parent #1/Guardian #1 Last Name *

Parent #2/Guardian #2 First Name *

Parent #2/Guardian #2 Last Name *

Home Street Address *

Unit#/Apt. #

City *

State *

Zip Code *

Main Email Address *

*

Main Contact Phone Number *

Does your child have any significant food allergies or medical conditions that we should be aware of? If so, please share those with us here. *

No, my child does not have any significant allergies or medical conditions.

Yes, my child has a significant allergy or a medical condition. Please describe in the box provided below. Yes, my child has a significant allergy or a medical condition. Please describe in the box provided below.

We may be able to offer child care to siblings 5 years and under. If this is an option when the class begins, would you use this perk? *

Yes, I would be interested in a free child care option

No, I will not need child care

If you answered YES to free child care, please list the NAME and AGE of the child you will be placing in child care.

Other Notes or Comments - please add here:

Tell us more about how you learned about this program: *

I have an older child who attends RBCPC Preschool

I am a church member

My child is part of HOPE Infant Program

I heard about you from a friend/relative

Other: Other:

Do you plan to continue in one of our Parent Child classes in the Spring? If so we recommend you submit that additional application now. Classes fill quickly. *

Yes - my child will still be 1 year old after January - REGISTERING for Learning Together Spring Session for children 12-24 months.

Yes - but my child will turn 2 in January. REGISTERING for our Growing Together class for children 24-36 months.

No, I will not be able to commit to the Spring Session at this time.

If you answered YES to the above question ....please click SUBMIT on this form THEN click on the appropriate link to submit the Spring Registration form