PRESCHOOL ENRICHMENT REGISTRATION FORM

Thank you for your interest in Springboard Experiences classes at:
Robert C Parker School
4254 Route 43
North Greenbush, NY 12198
Thursdays from 12:15pm-1:15pm

Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Parent Name *
Parent Name
Phone *
Phone
Address *
Address
Emergency Contact
Emergency Contact
Emergency Contact Phone Number
Emergency Contact Phone Number
Please list the first and last name of all adults authorized to pick up your child from class. Adults may be asked to show a photo ID at pick up.
Class Options *
Fees vary by month based on number of classes.