Registration Form

School Year 2019-20 is filling quickly – so please call us at 732-929-2500 to discuss availability.

Child's Information

Date of Birth

Home Address

Parents' Information

Parent/Guardian 1

Parent/Guardian 2

Physician/Emergency Contact:

Physician

Emergency Contact

In addition to the guardians listed above, who else is authorized to pick up your child?

Other Children in Family:

Are you registering your child for:

$125
$75

Weekly Schedule

Monday

Tuesday

Wednesday

Thursday

Friday

How did you hear about The Peppermint Tree?