Registration 2020-21

NAME_________________________________________________________SEX____

ADDRESS______________________________________________________________

AGE________BIRTH DATE____________________ TELEPHONE________________

PARENTS: MOTHER__________________________Cell number _______________

FATHER___________________________Cell number _______________

Email address________________________________________________

DAYS REGISTERED (choose 3 to 5 days)  

                 Monday 9-11:30                                               Monday 9-2:30

                 Tuesday 9-11:30                                               Tuesday 9-2:30

                 Wednesday 9-11:30                                         Wednesday 9-2:30

                 Thursday 9-11:30                                            Thursday 9-2:30

                 Friday 9-11:30                                                  Friday 9-2:30

NON-REFUNDABLE REGISTRATION FEE: $75.00

Date received____________________

Please circle days registered and mail to:

Grasshopper Green Preschool

1 Sterling city Road

Lyme, CT 06371

860/ 434-1844