3820 Windermere Pkwy, St #602, Cumming,
GA 30041
Mon - Fri : 5.30 PM - 8.30 PM
Sat and Sun Closed
Enrollment Options:
Child Information (Please print name exactly as it appears on the birth certificate.)
Parent / Guardian Information - Parent/Guardian #1
Parent / Guardian Information - Parent/Guardian #2
Emergency Contact Information (Persons to contact in the event that either parent/guardian cannot be contacted)
Cell Phone
Alternate Phone
I verify the above information to be correct, and I understand that completion of this form does not guarantee placement in the program. If my child is placed in the program, I agree that my child will attend the program for the required number of hours and days as prescribed/outlined by the center where my child is enrolled. I understand that I cannot register my child without appropriate age documentation. I have attached a copy of appropriate age documentation to this registration form.