Summer Program Registration

June 24th-June 28th 2019

9:00 a.m. to 1:00 p.m.

Monday through Friday

Name _____________________________ Sex __

Address____________________________________________

Age _____ Birthdate ______________Telephone ___________

Parents: Mother __________________Telephone ___________

Father __________________ Telephone ___________

Email address ____________________________________

Non-Refundable Deposit: $50.00

Date received ___________________

Week 1: JUNE 24th- June 28th

Monday through Friday 9-1:00 pm Total $150.00

Please complete and return with Registration Fee to:

Grasshopper Green Preschool

1 Sterling City Road

Lyme, CT 06371

(860) 434-1844