Learning Days: Learning Days: Trial Day Form

Trial Day

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We are looking forward to you child spending a Day with us. Please complete the form below and we will contact you soon!

Your Name *

Your Child's Name, Age *

Address *

City, State, Zip *

Home Number *

Cell Ph Number *

Best time to reach you *

Has Your child ever been to preschool *

Tell us about your child *

I would like to Subscribe to the Healthy Child Newsletter

I would like my child's Trial Day to be on the following day ( we will call you to confirm that this day is available) *

In case of an Emergency, Please transport my child to the following Hospital: *

Please list any allergies or medical conditions: *

How did you hear about us? *

Your Signature (Print your name) *

Date *

Please be sure that your child has the following on his/her trial Day: copy of Immunization Records,Blanket, Toddler size sheet, extra clothes and pull-up/diapers if potty training.

( * Required Field )

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