Registration Form

2011 Summer Early Childhood Classes

Completion of this form does not guarantee placement for the class. Registrants will receive conﬁrmation.
All classes are non-refundable and non-transferable except upon class cancellation. Classes are subject to cancellation based on minimum enrollment. Registrants will be notiﬁed of class cancellation within 48 hours of program start.

To register more than one child, please call 203 899 0606, ext. 247

Child Information

Child's Name

Child's Age

Parent/Guardian Information

Salutation

First Name

Last Name

Home address

Address 2

City

State

Zip

Phone

E-mail

Are you a member?

Yes

Indicates Response Required