Registration 2018-19
NAME_________________________________________________________SEX____
ADDRESS______________________________________________________________
AGE________BIRTH DATE____________________ TELEPHONE________________
PARENTS: MOTHER__________________________Cell number _______________
FATHER___________________________Cell number _______________
Email address________________________________________________
DAYS REGISTERED (choose 3 to 5 days)
Monday 9-11:30 Monday 9-2
Tuesday 9-11:30 Tuesday 9-2
Wednesday 9-11:30 Wednesday 9-2
Thursday 9-11:30 Thursday 9-2
Friday 9-11:30 Friday 9-2
NON-REFUNDABLE REGISTRATION FEE: $75.00
Date received____________________
Please circle days registered and mail to:
Grasshopper Green Preschool
1 Sterling city Road
Lyme, CT 06371
860/ 434-1844