Child Information

Name
Select One
DOB
Phone Number
Address
City, State, Zip

Parents' Information

Father's Name
Email Address
Mother's Name
Email Address

Please select desired program

5 Days - Mon-Fri
5 Days - Mon-Fri
5 Days - Mon-Fri
3 Days - Mon/Wed/Fri
3 Days - Mon/Wed/Fri
2 Days - Tues/Thurs
2 Days - Tues/Thurs

Preschool Length of Day

Early Care
Extended Day Program
Extended Day Late Program

Other

How did you hear about Chai Preschool?
Comments

Payment

New applicants, please include a one time, non-refundable administrative fee of $75.00 for enrollment.
Card Type
Exp Date
Card No
CVV Code