Child'sName *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father's Name

First Name

Last Name

Phone

(###)

###

####

Mother's Name

First Name

Last Name

Phone

(###)

###

####

Select Your Child's Attendance *

Full Time all Day (5+ hours per day) billed at $255 per seek

Full Time Half Day (Less than five hours per day) billed at $222 per week

Daily Full Time (5+ hours; Minimum of 3 days billed per week; minimum of 5 weeks) billed at $47 per day

Daily Part Time (Less than 5 hours; Minimum 3 days billed per week; minimum of 5 weeks) billed at $47 per day

Daily Use Only

Use the following box to select the days of service if (Daily Full Time) or (Daily Part Time) is selected. Note: You are confirming the schedule. We schedule accordingly and do not provide drop-in service.

MONDAY

Tuesday

Wednesday

Thursday

Friday

For Weekly Use, Select Weeks of Service

NOTE: We will be closed June 23-27 and July 4

June 9-13

June 16-20

June 30-July 3

July 7-11

July 14-18

July 21-25

July 28-August 1

August 4-8

August 11-15

August 18-22

Billing Frequency

1 payment due June 15

2 payments due June 15 and July 15

3 payments due June 15 and July 15 and August 15

A $55 non-refundable enrollment fee is required *

Understood

Late fee *

A $25 late fee will be assessed if payments are not received by due date

Understood

BrightWheel (R) *

Pathfinder Kids uses BrightWheel (R) to communicate and bill. This requires the end user to install BrightWheel (R) on their mobile device

Agreed