Summer Program Registration

June 24th-June 28th 2019


9:00 a.m. to 1:00 p.m.

Monday through Friday

 

Name _____________________________ Sex __

Address____________________________________________

Age _____ Birthdate ______________Telephone ___________


Parents:  Mother __________________Telephone ___________

               Father __________________ Telephone ___________

Email address ____________________________________

 

Non-Refundable Deposit:  $50.00

Date received ___________________

 



                                       Week 1:  JUNE 24th- June 28th

Monday through Friday  9-1:00 pm    Total $150.00

 

                                           

                            

Please complete and return with Registration Fee to:


Grasshopper Green Preschool

1 Sterling City Road

Lyme, CT  06371

(860) 434-1844