Enrollment Form

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Our Philosophy
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I am interested in enrolling my child into programming at Jasmin Child Care.

INITIAL ENROLLMENT FORM

PARENT / GUARDIAN INFORMATION

* Indicates required field

Name of Parent or Guardian *

First

Last

Address *

City *

Phone Number *

Email *

CHILD #1 INFORMATION

Child #1 - Name and Program *

First

Last

Choose the appropriate program: *

FULL-TIME: Infant Program (6 weeks to 12 months) - $210/week FULL-TIME: Toddler Program (1 year to 2 years) - $200/week FULL-TIME: Preschool Program (3 years to 5 years) - $185/week FULL-TIME: School Age Program (5 years and up) - $170/week PART-TIME: Infant Program (6 weeks to 12 months) - $195/week PART-TIME: Toddler Program (1 year to 2 years) - $185/week PART-TIME: Preschool Program (3 years to 5 years) - $140/week PART-TIME: School Age Program (5 years and up) - $120/week

Choose the hours you will need services: *

Standard Hours: 7am - 7pm Extended Hours: 7pm - 7am

Additional Information about this child: *

CHILD #2 INFORMATION

Child #2 - Name and Program *

First

Last

Choose the appropriate program: *

FULL-TIME: Infant Program (6 weeks to 12 months) - $210/week FULL-TIME: Toddler Program (1 year to 2 years) - $200/week FULL-TIME: Preschool Program (3 years to 5 years) - $185/week FULL-TIME: School Age Program (5 years and up) - $170/week PART-TIME: Infant Program (6 weeks to 12 months) - $195/week PART-TIME: Toddler Program (1 year to 2 years) - $185/week PART-TIME: Preschool Program (3 years to 5 years) - $140/week PART-TIME: School Age Program (5 years and up) - $120/week

Choose the hours you will need services. *

Standard Hours: 7am - 7pm Extended Hours: 7pm - 7am

Additional information about this child: *

CHILD #3 INFORMATION

Child #3 - Name and Program *

First

Last

Choose the appropriate program: *

FULL-TIME: Infant Program (6 weeks to 12 months) - $210/week FULL-TIME: Toddler Program (1 year to 2 years) - $200/week FULL-TIME: Preschool Program (3 years to 5 years) - $185/week FULL-TIME: School Age Program (5 years and up) - $170/week PART-TIME: Infant Program (6 weeks to 12 months) - $195/week PART-TIME: Toddler Program (1 year to 2 years) - $185/week PART-TIME: Preschool Program (3 years to 5 years) - $140/week PART-TIME: School Age Program (5 years and up) - $120/week

Choose the hours that you will need services: *

Standard Hours: 7am - 7pm Extended Hours: 7pm - 7am

Additional Information about this child: *

Any other information that you would like to share: *

Submit

Call today to schedule a tour!

OPERATING HOURS:

Monday - Friday
7:00AM - 5:30PM

NEW: Extended Hours program - 7pm to 7am

TELEPHONE:

701.281.6025

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Our Philosophy
Connect with us / forms