Forest Park Learning Center
Welcome to Forest Park Learning Center!
Parent Name
*
Child Name
*
Child Date of Birth
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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My child will be at least 3 years of age and fully potty trained by September 1, 2026.
*
Please select one option.
Yes
No
Emergency Contact Name
*
Emergency Contact Phone
*
Any allergies or health concerns for the child:
Child's favorite color:
Please provide 3 names and phone numbers of individuals (other than parents) that you authorize to pick up your child. PLEASE NOTE: if their name is not listed, your child will not be released to them regardless of familiarity.
*
I do hereby grant my permission for the use of my child's image to be used in future marketing and social media publication.
*
Please select one option.
yes
no
I understand that my registration is pending until the $100 supply fee is paid, due by 8/30/26.
*
Please select all that apply.
yes
no
Payments
monthly tuition if registered before 5/30/26 ($120)
monthly tuition for returning family ($120)
monthly tuition if registered after 5/30/26 ($180)
supply fee (due August 2026 & January 2027 ($100)
monthly tuition if registered before 5/30/26 ($120)
monthly tuition for returning family ($120)
monthly tuition if registered after 5/30/26 ($180)
supply fee (due August 2026 & January 2027 ($100)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Welcome to Forest Park Learning Center!
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