Spring 2019 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 16 weeks long and runs on Mondays or Tuesdays, starting the week of January 14 through May 20. The cost is $192 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? *

THIS CLASS IS FULL - Monday 10:30am - 11:30am

THIS CLASS IS FULL - Tuesday's 9am - 10 am

Tuesday's 10:30 - 11:30 am

What is your second choice for a class time? *

Monday 10:30am - 11:30am - Since this class is FULL - we can only accept waitlist names. Click here to be placed on the waitlist.

Tuesday's 9am - 10 am - Since this class is FULL - we can only accept waitlist names. Click here to be placed on the waitlist.

Tuesday's 10:30 - 11:30 am

What is your third choice for a class time? *

Monday 10:30am - 11:30am -Since this class is FULL - we can only accept waitlist names. Click here to be placed on the waitlist.

Tuesday's 9am - 10 am Since this class is FULL - we can only accept waitlist names. Click here to be placed on the waitlist.

Tuesday's 10:30 - 11:30 am

Child's Gender *

Male

Female

Please tell us your child's date of birth. 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.

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.

Other Notes or Comments - please add here: