Application

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Program of Interest (Check all that apply) *

Parent & Me (starting age 12 months, weekly class to be attended the year prior to starting preschool)

Yellow Group (starting age 2 by September 1st to 3)

Blue Group (starting age 3 by September 1st to 4)

Red Group (starting age 4 by September 1st to 5 ½)

Parent 1 - Name *

First Name

Last Name

Parent/Guardian 1 - Phone Number *

(###)

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Parent/Guardian 2 - Name

First Name

Last Name

Parent/Guardian 2 - Phone Number

(###)

###

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Primary Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tour Date Attended / Planning to Attend *

MM

DD

YYYY

$75 Application Fee *

Required and non-refundable.

I will pay via PayPal on the next step of this form.

I will mail a check made out to Little VIllage Nursery School - 11827 Pico Blvd., Los Angeles, CA 90064