Registration Form

All Fields required
OPEN ENROLLMENT BEGINS MARCH 3, 2011
In-house applicants will receive first consideration for 2 weeks (until
March 17, 2011) - then applications will be first come, first serve.

Child's Last Name
Child's First Name Middle Initial
Date Of Birth (mm/dd/yyyy)
Male Female
Asian Black Caucasian Hispanic Other
Father's Name
Address
City State Zip Code
Home Phone Cell
Email
Employer
Employer's Phone
Mother's Name
Click here if address/home phone is same as Father's
Address
City State Zip Code
Home Phone Cell
Email
Employer
Employer's Phone
Family Information:
Sibling's Name Age School
Sibling's Name Age School
Sibling's Name Age School
Child’s Previous Preschool or Daycare Experiences:

School/Day Care Provider 1 Days
Times Phone
School/Day Car Provider 2 Days
Times Phone
Yes, I authorize all staff employed through CECC access to all information in my child’s file including: health, personal, and academic information.

Please complete program selection for 3 & 4 yr olds: Please indicate which program you would like to enroll your child in by showing your 1st, 2nd, and 3rd choice.
2 day a Week Program (3 year olds only) 3 Year Old AM - Monday and Tuesday, 8:30 AM – 11:00 AM Tuition = $1075.00 or 4 payments of $268.75 3 Year Old PM - Monday and Tuesday, 12:00 AM –2:30 AM Tuition = $1075.00 or 4 payments of $268.75
Mixed-Age - 3 Day a Week Program Mixed-Age AM- Wednesday, Thursday, Friday, 8:30 AM – 11:00 AM Tuition = $1575.00 or 4 payments of $393.75 Mixed-Age PM - Monday and Tuesday,12:00 PM – 2:30 PM Tuition = $1575.00 or 4 payments of $393.75
Mixed-Age - 5 Day a Week Program Mixed-Age AM, Monday – Friday, 8:30 AM – 11:00 AM Tuition = $2175.00 or 4 payments of $543.75 Mixed-Age PM, Monday – Friday, 12:00 PM – 2:30 PM Tuition = $2175.00 or 4 payments of $543.75
Readiness Applications May Be Sent in at Any Time.
Yes, we would like to apply for School Readiness Program
Lunch Bunch – Please check if you are interested**