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Student Information

Children REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- What program are you registering for? REQUIRED Please fill out this field.
- Anticipated school start date REQUIRED Please fill out this field. Please enter a date.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- What program are you registering for? REQUIRED Please fill out this field.
- Anticipated school start date REQUIRED Please fill out this field. Please enter a date.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- What program are you registering for? REQUIRED Please fill out this field.
- Anticipated school start date REQUIRED Please fill out this field. Please enter a date.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- What program are you registering for? REQUIRED Please fill out this field.
- Anticipated school start date REQUIRED Please fill out this field. Please enter a date.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Parent/Guardian Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Relation to student REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Primary email REQUIRED Please fill out this field. Please enter an email address.

Meadowbrook Child Garden Policy - Click to read

I have read school's privacy policy and understand Meadowbrook Child Garden's use of my child's name in this online system. REQUIRED Yes No Please fill out this field.

*I agree that all the information above is accurate

Your signature (Type fully name) REQUIRED Please fill out this field. Please enter valid data.

After submission, the remainder of the registration packet will be sent to you. Thank you!