Open House 8/28
Parent 1 Information
First Name
Last Name
Email
Cell phone
Home Address
Employer
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Call
Text
Email
call
text
email
If you are new to our Children's Lighthouse location, please fill out your Child's information below. If you have previously provided this information to us, you can skip this step. We are looking forward to seeing you!
Child 1
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Program
Full Time
Part Time
After School
Summer Only
Try Out
Before School
Before and After School
Child 2
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Program
Full Time
Part Time
Before School
After School
Before & After School
Try Out
Summer Only
full time
part time
try out
summer only
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