Kids Express Learning Center 2002-2003 School Year Enrollment Application August 22, 2002 to June 5, 2003

Child's Name:
M or F	(circle one)
Date of Birth:
Home Telephone:
Street Address (Home):
City/State/Zipcode:
Mother's Name:
Place of Employment:
Work Telephone:
Father's Name:
Place of Employment:
Work Telephone:
Does Your child have any special needs? Please explain:
Requested Enrollment Schedule: (Please indicate the first and second choice of the following options listed below.)
Full Day Options Hours: 8:00 a.m. - 3:30 p.m.
5 days per weeks
3 days per weeks (M,W,F)
2 days per weeks (T,Th)
Half Day Options Hours: 8:15 a.m. - 11:30 p.m. or 12:30 p.m. - 3:45 p.m.
5 days per weeks
3 days per weeks (M,W,F)
2 days per weeks (T,Th)
Check One:
My child will attend Kids Express Learning Center's half day option in the morning. My child will attend Kids Express Learning Center's half day option in the afternoon.
Extended Hours Options Please check all days when your child will attend Before/After School:
Before School (7:30 a.m. - 8:00 a.m.)
Monday  Tuesday Wednesday  Thursday Friday
After School (3:30 p.m. - 5:30 p.m.)
Monday  Tuesday Wednesday  Thursday Friday
My child's first day of school will be:
Kids Express Learning Center's School Year Begins on Wednesday, August 22, 2002.
Please print and complete this enrollment application and mail to: Dr. Sandra S. Dahl Kids Express Learning Center Prairie View Farm 3276 High Point Road Madison, WI 53719 608.845.DAHL (3245) A non-refundable processing fee of $50.00 must accompany this Enrollment Application. Upon receipt of this Enrollment Application and fee, your child's name will be placed on our potential enrollment list. Prior to your child's first day of school, you will receive an enrollment agreement to verify your child's acceptance and schedule. Once the enrollment agreement is signed and returned with a tuition deposit, a packet of registration materials will be sent to your home address.
For Office Use Only
Check Number: Amount:Date:
Class:Director: Entered: