Child's InformationName* Select One* Male Female Date of Birth* MM slash DD slash YYYY Phone*Address* City/State/Zip* Parents' InformationFather's Name* Email* Mother's Name* Email* Desired ProgramPlease select* 5 Days – Mon-Fri 3 Days – Mon/Wed/Fri 2 Days – Tues/Thurs Preschool Length* 9:00am-12:30pm – Core Program 12:30-3:30pm – Extended Care Program OtherHow did you hear about Gani PreschoolCommentsApplication Fee*New applicants, please include a one time, non-refundable administrative fee of $50.00 for enrollment. Aplication Fee Will send check PaymentCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Total $0.00 2020-02-05
