Fall 2021 Learning Together Class Application (Parents with Children 12-24 months)

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 12 weeks long and runs on Tuesdays & Wednesdays, starting the week of September 13th through December 8th. The cost is $156.00 for the entire session. Cash or checks (payable to RBCPC Preschool) are accepted.

Child's First Name *

Child's Last Name *

What is your first choice for a class time? *

Tuesdays 9:30 am - 10:30 am

Wednesdays 9:30am - 10:30am

What is your second choice for a class time? *

Tuesdays 9:30 am - 10:30 am

Wednesdays 9:30am - 10:30am

Child's Gender *

Male

Female

Your Child's birth date? +

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.

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:

Other Notes or Comments - please add here:

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 by 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