Registration

Summer 2019 is almost completely booked, so please call first to find out about availability before registering. School Year 2019-20 is also filling quickly – so please call us at 732-929-2500 to discuss availability.

Child's Information

* denotes "required" field

First Name*:

Last Name*:

Date of Birth*:

Previous School Experiences:

Home Address

Street 1*:

Street 2:

City*:

State*:

Zip Code*:

Home Phone*:

Parents' Information

Parent/Guardian

First Name:

Last Name:

Cell Phone:

Occupation:

Employer:

Work Phone:

Parent/Guardian 2

First Name:

Last Name:

Cell Phone:

Occupation:

Employer:

Work Phone:

Family Email*:

Physician/Emergency Contact:

Physician

Family Physician:

Telephone:

Does child have any physical or mental handicaps or special fears/habits?

Emergency Contact

Emergency Contact:

Telephone:

Who is authorized to pick up your child?

1 - Name:

2 - Name:

Code Word:

Other Children in Family:

Name:

Age:

Weekly Schedule
	From:	To:	# of Hours:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday*

* Saturday is restricted to “My Parent and Me” ONLY!

Desired Start Date (mm/dd/yy):

How did you hear about The Peppermint Tree?

Television Advertisement

Mailing

Personal Referral

Print Ad or other P.R.

Magazine or Journal Article

Search Engine or Directory

Other

Explain:

After you submit this form, you'll have the option to pay the Registration Fee online.

1571 Partridge Street . Toms River . NJ 08753 . (732) 929-2500

The Peppermint Tree Child Development Center, offering child care in Toms River NJ, is a state-certified, privately owned, non-sectarian, non-denominational center that offers a program developed for young, inquisitive minds. The Peppermint Tree is a proud participant in Grow NJ Kids, to assure high quality early childhood education for our children.

Peppermint Tree

Registration

Child's Information

Home Address

Parents' Information

Parent/Guardian

Parent/Guardian 2

Physician/Emergency Contact:

Physician

Emergency Contact

Other Children in Family:

Are you registering your child for:

Child's Calendar

Weekly Schedule

How did you hear about The Peppermint Tree?

eMail Sign Up

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Pay Tuition Online!

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