Enrollment

Parent/Guardian #2 Information: *

Phone Number: *

Child's Physician & Phone Number: *

Enrollment Application

Child's Name: *

Parent/Guardian #1 Information: *

1176 East Main Street, Shrub Oak, NY 10588, USA
+1.914.245.3610

Child's Date of Birth: *

Once your application is approved, a $100.00 non-refundable deposit which covers your child's insurance for the school year and secures your child's enrollment at Kiddie Kottage is required.

Sibling(s): *

Address: *

List Two Emergency Contacts and Phone Number: *

Child's Name: