Spring 2021 Growing Together Class for Parents and Children 24-36 + months Registration Request Form

Complete and submit this form to apply for enrollment in our class for parents and children

24-36+ months. In this class, enjoy 1 hour and 30 minutes of time inside the classroom, outside on the playground, as well as a group time with the parent educator. Together you will explore developmental activities and observe how your 24-36+ month old learns through PLAY! Thematic learning is used to explore science, art, music and more.

Classes are on Thursdays or Fridays starting January 20 through May 28. Session runs 17 weeks and is $331.50. 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? *

What is your second choice for a class time? *

What is your third choice for a class time? *

What is your fourth choice for a class time? *

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 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 of our program. *

I have an older child who attends 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 love this option

No, I will not need child care

If you answered YES to being interested in 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: