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Little Learners Preschool
License #093615287
Application For 2010-2011 Enrollment
Child’s Name: ____________________________ Birthdate: _____________ Sex: M [] F []
Mother’s Name _______________________________________________________________
Address: _______________________________ City/State/Zip _________________________
Home Phone: (_______)__________________ Work Phone: (_______)_________________
Parent’s Occupation: ____________________ Cell Phone: (_______)___________________
Parents’ Employer: ______________________ E-mail Address: _______________________
Father’s Name ________________________________________________________________
Address: _______________________________ City/State/Zip _________________________
Home Phone: (_______)__________________ Work Phone: (_______)_________________
Parent’s Occupation: ____________________ Cell Phone: (_______)___________________
Parents’ Employer: ______________________ E-mail Address: _______________________
School Day Preferences
____ 3 yrs of age (by 8/1/10)
Monday, Wednesday, and Friday 8:30-11:30am ?
Tuesday and Thursday 8:30-11:30am ?
About Your Child:
Please tell us about your child: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Does your child have any food restrictions or special requirements? _____ no _____ yes
Please explain: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sibling Information:
Name: _____________________________________________ Birthdate: _________________
Name: _____________________________________________ Birthdate: _________________
Name: _____________________________________________ Birthdate: _________________
TUITION: $300/month for Monday, Wednesday, and Friday AM, $200/month for Tuesday and Thursday AM,
Payment must be received by the 5th of each month.
Return to: Shauna Erickson
Little Learners Preschool
4330 Rimini Way
El Dorado Hills, CA 95762
PLEASE RETURN THIS FORM WITH YOUR $75.00 NON-REFUNDABLE APPLICATION FEE
Make checks payable to: Little Learners Preschool
For more information call: Miss Shauna at (916) 365-5664
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