Admissions

Desired year of enrollment *

Have You Toured? *

Home Phone *

Child's Name *

Child's Birthday *

Child's Gender *

Address *

City / State *

ZIP Code *

Parent 1 Name *

Parent 1 Occupation

Parent 1 Employer

Parent 1 Cell Phone *

Parent 2 Name

Parent 2 Occupation

Parent 2 Employer

Parent 2 Cell Phone

Upload a Family Photo *

E-Mail we should use to communicate with you *

How did you hear about us?

Which factors led to your decision to apply to The Playgroup House?

Class Day/Time Preference

Please rank your 1st, 2nd, and 3rd choice preferences for the class day and time you wish to enroll (i.e MWF - 1st choice, TU/TH - 2nd choice, etc.)

Application Fee: $130

Upon submitting your application you will be redirected to our payment processor to pay the $130 fee

Application Fee

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Name