Forest Park Learning Center

Welcome to Forest Park Learning Center!

Parent Name

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Child Name

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Child Date of Birth

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Email

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This address will receive a confirmation email

Phone

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Address

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My child will be at least 3 years of age and fully potty trained by September 1, 2026.

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Please select one option.

Yes No

Emergency Contact Name

*

Emergency Contact Phone

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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.

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I do hereby grant my permission for the use of my child's image to be used in future marketing and social media publication.

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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.

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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)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Welcome to Forest Park Learning Center!

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