2013-2014

Child's Name: __________________ Parents Names: _____________________________________________________________________ Address: City: Home Phone: Cellular Phone: Work Phone: Email Address: _______________________________________ Zip Code: Date of Birth:

Mark Class Choice:

Grasshopper

(Age 2* by August 31)

Tuition: $120/Month Tuesday/Thursday 9 AM - 11:30 AM Tuition: $150/Month Monday/Wednesday/Friday 9 AM - 11:30 AM Tuition: $150/Month Monday/Wednesday/Friday 12:30 PM - 3:30 PM

] BUMBLEBEE
(Age 3* by December 31)

] BUTTERFLY
(Age 4* by August 31)

*Variations from age guidelines must be pre-approved by the teacher & are subject to a 4-week trial. Registration fees: $75 for new families. Each additional child is $25. Registration fees for returning families is $40. Each additional child is $20.00

This non-refundable fee is due at the time of registration.

Scholarships are available for those of financial need or special circumstances. I am interested in scholarship information: YES NO

Child's race/ethnic origin: keeping) How did you hear about us?

(Optional, for tax-exempt record

Make checks payable to: Lacey Co-op Preschool Do you have a Question? Call 4595297 Send Registration form and fee to: P.O. Box 5814, Lacey WA 98503 ** First month tuition (1/2 month) + last month tuition + registration fee
** 10 % discount for Military, $20 off if more than one child enrolled, $20 off for referral that enrolls

Registration Fee Received by:

Amount Received:$

Cash/Check#