Fundamentals Child Development Center, LLC

First Child's Name *

Age *

Sex *
male
female

Date of Birth First Child *

Second Child's Name

Age

Sex
male
female

Date of Birth Second Child

Third Child's Name

Age

Sex
male
female

Date of Birth Third Child

Parent/Guardian Name *

Phone Number *

Wireless Provider

Mailing Address *

Email Address *

Parent/Guardian Name

Phone Number

Wireless Provider

Mailing Address

Email Address

Desired Tuition Slot *
8:30-2:30 (30 hours)
7:30-4:00 (42 hours)
7:30-5:30 (50 hours)
No Full Time Slot Preferred

Desired Program *
Infants 8wk-12m
Waddlers 12m-20m
Toddler I 18m-25m
Toddler II 25m-39m
Preschool 3y-5y

Half Day Slots for Preschool Program Only *
9:00-12:00 M-W-F
9:00-12:00 T-R
No Half Day Slot Preferred

Preferred Start Date

How did you hear about Fundamentals?

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Fundamentals Pre-Enrollment Form