Nathalie Hudyana

Student Name*

First Last

Parent Name*

First Last

Email*

Home Phone*

Cell Phone

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Does your child have any allergies?*

Yes
No

Please List Allergies

Kindergarten Enrichment

Kindergarten Term 1: February 6 – April 1 (8 weeks)
Kindergarten Term 2: April 24 – June 17 (8 weeks)
Kindergarten Term 3: July 17 – September 9 (8 weeks)
Kindergarten Term 4: October 9 – November 11 (5 weeks)

Pre-Primary Enrichment

Pre-Primary Term 1: February 6 – April 1 (8 weeks)
Pre-Primary Term 2: April 24 – June 17 (8 weeks)
Pre-Primary Term 3: July 17 – September 9 (8 weeks)
Pre-Primary Term 4: October 9 – November 11 (5 weeks)

Kindergarten Term 1

Monday: 2:30 - 3:30pm
Thursday: 2:30 - 3:30pm
Saturday 11:00-12:00am

Kindergarten Term 2

Monday 2.30-3.30pm
Thursday 2.30-3.30pm
Saturday 11:00-12:00am

Kindergarten Term 3

Monday 2.30-3.30pm
Thursday 2.30-3.30pm
Saturday 11:00-12:00am

Kindergarten Term 4

Monday 2.30-3.30pm
Thursday 2.30-3.30pm
Saturday 11:00-12:00am

Pre-Primary Term 1

Monday 4-5pm
Thursday 4-5pm
Saturday 10-12am

Pre-Primary Term 2

Monday 4-5pm
Thursday 4-5pm
Saturday 10-12am

Pre-Primary Term 3

Monday 4-5pm
Thursday 4-5pm
Saturday 10-12am

Pre-Primary Term 4

Monday 4-5pm
Thursday 4-5pm
Saturday 10-12am

Additional Programs

Holiday Workshop Program

I would like to suggest the following class date and time.

What are the strengths and needs of your child academically and socially?

Can I use pictures of your child in class for promotional purposes?*

Yes
No

WAIVER AND RELEASE OF LIABILITY*

I Agree

By checking the "I Agree" button, I understand that I am agreeing to the enclosed waiver and release of liability. I release and hold harmless Early Education Enrichment (EEE) and any of its agents from any liability as a result of personal injury or property damage sustained by me or my children while attending the EEE program. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury sustained by me or any of my family members while attending any of the EEE classes. I waive, fully discharge any claims, and release from any and all liability EEE and its agents.

Name

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2017 Schedule

Term 1: Weeks of February 6 – April 1 (8 weeks)

Term 2: Weeks of April 24 – June 17 (8 weeks)

Term 3: Weeks of July 17 – September 9 (8 weeks)

Term 4: Weeks of October 9 – November 11 (5 weeks)

Address: