TLC Application Page

Application Form

Student Information

* Indicates required field

Student's Name *

First

Last

Date of Birth *

Sex *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Any Allergies? *

Yes No

If so, what? *

Anything Else we need to know about your child? *

Parent's Information

Mother's Name *

First

Last

Address (If different from student) *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Occupation *

Place of Work *

Work Phone Number *

Email *

Father's Name *

First

Last

Address (If different from student) *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Occupation *

Place of Work *

Work Phone Number *

Email *

Siblings:

Name *

First

Last

Sex *

Age *

Name *

First

Last

Sex *

Age *

Name *

First

Last

Sex *

Age *

Does your family regularly attend church? *

Yes No

If so, where? *

Emergency Contact (other than parent) *

First

Last

Phone Number *

Babysitter's Name (Daytime sitter) *

First

Last

Phone Number *

Classes Offered

3 Year Olds - *$90.00 per month *

2 day 3 year olds meeting Mon./Wed. 9:30-11:30am 2 day 3 year olds meeting Tues./Thurs. 9:30-11:30am

4 Years Olds *

4 day 4 year olds meeting Mon.-Thurs. 9:30am-12:00pm *$155.00 Per Month 2 day 4 year olds meet Tues. & Thurs. 9:30 am-12:00 pm $100 per month

*Tuition costs are subject to change

I understand that I will pay the monthly tuition cost for the class I have chosen above. There is a $50.00 non-refundable registration fee if paid by August 9th. Starting August 10th the non-refundable registration fee is $60.00. The registration fee includes the cost of a TLC T-shirt (to be given out the first week of school.) I will give a 30 day notice if I have to withdraw my child from TLC at any time and I am responsible for tuition during that period of time. *

I Understand

We cannot guarantee a place for your child until the
registration form and registration fee have been received.

Signature *

T-shirt size (choose one) *

2/4 6/8 10/12

I have enrolled my child in the Universal Pre-K program *

Yes No

Submit