Spring 2021 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 runs on Tuesdays or Wednesdays, starting the week of January 19 through May 19. The cost is $208 for the entire session (16 weeks). 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 9am - 10 am

Tuesdays 10:30 - 11:30 am

Wednesdays 9am-10am

What is your second choice for a class time? *

Tuesdays 9am - 10 am

Tuesdays 10:30 - 11:30 am

Wednesdays 9am-10am

What is your third choice for a class time? *

Tuesdays 9am - 10 am

Tuesdays 10:30 - 11:30 am

Wednesdays 9am-10am

Child's Gender *

Male

Female

What is 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 does have any significant allergies or medical conditions. Please describe in the box provided. Yes, my child does have any significant allergies or medical conditions. Please describe in the box provided.

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

I have an older child who attend RBCPC Preschool.

I am a church member

My child is part of the HOPE Infant Program

I heard about you from a friend/relative

Other: Other:

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 (if we are able to offer it)

Other Notes or Comments - please add here: