Pre-Enrollment

Child’s Information:

Child’s Name

Date of Birth // Gender M F

Home Address

City State Zip Code

Home Phone

Mother’s Information

Mother’s Name

Employer Daytime Telephone

Cell Phone Number Email Address

Father’s Information

Father’s Name

Employer Daytime Telephone

Cell Phone Number Email Address

Enrollment:

Expected Date of Enrollment //

I certify that the information give in this document is correct to the best of my knowledge. I am aware that I must pay a non-refundable registration fee in order to secure my child's spot.

Childrens Lighthouse, San Antonio TX

San Antonio

210-495-ABCD

Info@ChildrensLighthouseSA.com
20906 Gathering Oak
San Antonio, TX 78260

San Antonio, 20906 Gathering Oak, San Antonio, TX 78260

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