The Child Day Schools Lafayette Enrollment for Children's Education

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Entry Date

How many children would you like to enroll?*

Your Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email Address*

Email Confirm Email

Child's Name

First Last

Child's Birth Date*

Enrollment

Would you like to enroll this child full time or part time?
Please select one.

Preferred Start Date

Second Child's Name

First Last

Second Child's Birth Date*

Second Child's Enrollment

Would you like to enroll this child full time or part time?
Please select one.

Second Child's Preferred Start Date

Third Child's Name

First Last

Third Child's Birth Date*

Third Child's Enrollment

Would you like to enroll this child full time or part time?
Please select one.

Third Child's Preferred Start Date

If you have further questions or comments, please let us know.

How did you hear about us?

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Other*

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Enrollment Request for The Child Day Schools - Lafayette