Building Blocks Preschool

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Class Options:

A- T/Th: 8:30-11:00 $90
B- MWF: 8:30-11:00 $130
C-M-Th: 12:30-3:00 $165
D- M-F: 8:30-11 $200
E-M-F: 12:30-3:00 $200

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Child's Name

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Last

Date of Birth

Gender

Special Physical/Social/Emotional Needs

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #1 Information

Parent/Guardian #1 Name

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Last

Parent/Guardian #1 Phone Number

Parent/Guardian #1 Email

Parent/Guardian #1 Employer

Parent/Guardian #2 Information

Parent/Guardian #2 Name

First

Last

Parent/Guardian #2 Phone Number

Parent/Guardian #2 Email

Parent/Guardian #2 Employer

A- T/Th: 8:30-11:00 $90 B- MWF: 8:30-11:00 $130 C-M-Th: 12:30-3:00 $165 D- M-F: 8:30-11 $200 E-M-F: 12:30-3:00 $200

First Preference

2nd Preference