Child's InformationName*Select One*MaleFemaleDate of Birth* Date Format: 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-Fri3 Days - Mon/Wed/Fri2 Days - Tues/ThursPreschool 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 FeeWill send checkPaymentCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Total $0.00 2020-02-05