PRESCHOOL ENRICHMENT REGISTRATION FORM

Thank you for your interest in Springboard Experiences classes at:
St Stephen's Preschool Academy
16 Elsmere Avenue
Delmar, NY 12054
12:30pm-1:30pm

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.