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