** ATTENTION **

    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:

    1. 1. Complete the pre-enrollment form
    2. 2. Wait to receive paperwork via email
    3. 3. Complete and return all paperwork
    4. 4. Activate Brightwheel account
    5. 5. Pay deposit and confirm start date
    Parents Info
    1. EmailText MessagePhone Call
    Child/Children Info
    Child/Children Names
    Date of Birth or Due Date
    Desired Start Date
    Program Pricing
    1. Wee Ones Nursery Care age 6 weeks to 24 months: Full Time $315/week
    2. Orange Class age 18 months to 36 months: Full Time $300/week
    3. Yellow Class age 3 - 4 years old: Full Time $290/week
    4. Green Class age 4 - 5 years old: Full Time $280/week
    Program Options
    1. Wee Ones Nursery Care age 6 weeks to 24 monthsOrange Class age 18 months to 36 monthsYellow Class age 3 - 4 years oldGreen Class age 4 - 5 years old
    Additional Information and/or Questions