Admission Application

Child's Information
Name*
Select One*
- Male
- Female
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Address*
City/State/Zip*
Parents' Information
Father's Name*
Email*
Mother's Name*
Email*
Desired Program
Please 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
Other
How did you hear about Gani Preschool
Comments
Application Fee*
New applicants, please include a one time, non-refundable administrative fee of $50.00 for enrollment.
- Aplication Fee
- Will send check
Payment
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00

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Child's Information