* Attention *

Disclaimer

Completing this form does not ensure a childcare spot at Pipsy’s. This form is to request additional information. The enrollment process is as follows:

Complete the pre-enrollment form
Wait to receive paperwork via email
Complete and return all paperwork
Activate Brightwheel account
Pay deposit and confirm start date

Parent Information

Parent 1 Name *

Parent 1 Email *

Parent 1 Phone

Parent 2 Name

Parent 2 Email

Parent 2 Phone

Preferred Method of Contact:EmailPhone Call

Child/Children Information

Child 1 Name *

Child 1 Date of Birth *

Month

Day

Year

Child 2 Name

Child 2 Date of Birth

Month

Day

Year

Child 3 Name

Child 3 Date of Birth

Month

Day

Year

Child 4 Name

Child 4 Date of Birth

Month

Day

Year

Child 5 Name

Child 5 Date of Birth

Month

Day

Year

Is your child/are your children potty trained? *Yes, all my children are potty trainedNo, none of them are potty trainedNot all of them, but some are potty trained

Who is potty trained? *Please list everyone that is potty trained.

Children Under 3

Are any of your children under 3 years of age? *Yes, I have one under 3Yes, I have multiple under 3No, all my children are older than 3 years old

How many naps does your child take per day? *

How many naps do your children take per day? *Please let us know how many naps for each of your children.

Is your child still taking *a bottle?milk?formula?Please select all that apply.

Is at least one of your children still taking *a bottle?milk?formula?Please select all that apply.

Is your child walking independently? *YesNo

Are any of your children walking independently? *Yes, at least one can walkNo, nobody can walk quite yet

Program Information

Program Pricing

Wee Ones Nursery Care (0 – 24 months): Full Time $325/week

Toddler Nursery: Full Time $315/week

Main Room age (Kindergarten Prep): Full Time $300/week

Desired Start Date *

Month *

Day *

Year *

Program Options *Wee Ones Nursery Care age 0 – 12 monthsToddler Nursery age 12 – 24 monthsMain Room age 2 – 4 years old

Additional Information and/or Questions

* Attention *

Parent Information

Child/Children Information

Children Under 3

Program Information

Events

Upcoming Events

Closure – Good Friday

Closure – Memorial Day

Closure – 4th of July

Closure – Labor Day

Closure – Thanksgiving

*** Attention ***

Parent Information

Child/Children Information

Children Under 3

Program Information

Events

* Attention *