EmailMe Form - JUNE-AUGUST 3 Week Day Care Registration

Child's Name *

First Last

Parent's Name *

First Last

Person completing the survey

Email *

Continued Registration
FIRST 3 week session: *

Please register me for day care June 29-July 17th

We do not want to register for this time period

Days/ Week during FIRST 3 week session *

3

4

5

Does not apply

I understand that full time families take priority and if there is limited space part time families may be given a week's notice for full time families to take their spot. Any new families entering will be screened to have not participated in activities for the prior three weeks

Continued Registration
SECOND 3 week session: *

Please register me for day care July 20-Aug 7th

We do not want to register for this time period

Days/ Week during SECOND 3 week session *

3

4

5

Does not apply

I understand that full time families take priority and if there is limited space part time families may be given a week's notice for full time families to take their spot. Any new families entering will be screened to have not participated in activities for the prior three weeks

Are you receiving state funding? *

Yes

No

CURRENT FAMILIES:
I give you permission to charge us right away to reserve our spot. The charges will be for the session and days/week I am requested above at the rate of $73.80/day *

Yes, full amount

If recieving aid, I give permission to be charged for the amount the subsidy will not cover.

I believe a charge should not be required because aid should cover the entire cost.

I am not a current family

NEW FAMILIES:
I understand that I will be contacted if space os available and I understand I will have to provide payment in order to reserve my spot. *

Yes

I am not a new family

I understand refunds are not an option and credit is up to the discretion of Kids N Dance *

Yes

Any added thoughts, concerns. We welcome your feedback as always.