Child's Name:

Age of Child by 9/30/12:

Gender:

Select One Male Female

Birthdate:

FATHER

MOTHER

Father's Name:

Mother's Name:

Address:

Address:

City:

City:

Zip:

Zip:

Home Phone:

Home Phone:

Work Phone (Father):

Work Phone (Mother):

E-mail address:

Are you a registered member of St. Cecilia Parish?

Yes  No

Program Description (Please pick a first and second choice)

MIXED AGE GROUPING  -   (3, 4 and 5 year olds)

A program to meet the needs of the child to explore, discover, and experiment in the environment through creative play, as well as interact with other age children.

Class

"BLUE" CLASS

Days: 

Tuesday and Thursday

Time: 

9:00 a.m. to 11:30 a.m.

Age:

Must be 3 years old by SEPTEMBER 30, 2012

Cost:

$140.00 per month

"PURPLE" CLASS

Days: 

Monday, Wednesday and Friday

Time: 

9:00 a.m. to 11:30 a.m.

Age:

Must be 3 years old by SEPTEMBER 30, 2012

Cost:

$160.00 per month

"YELLOW" CLASS

Days: 

Monday, Wednesday and Friday

Time: 

12:45 p.m. to 3:15 p.m.

Age: 

Must be 3 years old by SEPTEMBER 30, 2012

Cost:

$160.00 per month

"TAN" CLASS

Days:

Monday, Wednesday and Friday

Time:

9:00 a.m. to 11:30 a.m.

Age:

Must be 4 years old by SEPTEMBER 30, 2012

Cost:

$160.00 per month

Days: 

Monday-Friday

Time: 

12:45 p.m. to 3:15 p.m.

Age:

Must be 5 years old by MAY 31, 2013

Cost:

$210.00 per month