Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Child's Name *

First Name

Last Name

Are you interested in 3- or 5-day care? *

3-Day

5-Day

If you're interested in 3-day care, please select the three days that your child will be attending:

Monday

Tuesday

Wednesday

Thursday

Friday

Do you prefer the A.M. or the P.M. session?

***A.M. Session indicates that you would be dropping your child off at The Learning Bridge IN THE MORNING. ***P.M. Session indicates that you would be picking your child up at The Learning Bridge IN THE AFTERNOON.

A.M.

P.M.

For PM session only, are you interested in extended hours?

Yes, I will pick up my child between 4-5 p.m.

No, I will pick up my child at 4 p.m.