Toddler & Me registration form

Thank you for your interest in the Toddler & Me program!

This class will be held at/from:
St Stephen's Preschool Academy
16 Elsmere Avenue
Delmar, NY 12054
Wednesdays 1/4, 1/11, 1/18, 1/25
9:45-10:15am

Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Caregiver's Name *
Caregiver's Name
Phone *
Phone
Address *
Address
Emergency Contact
Emergency Contact
Emergency Contact Phone Number
Emergency Contact Phone Number
Photo Release *
Springboard Experiences requests permission to use images taken during our programs on our website and Facebook page.