Registration 20xx20xx *Student DetailsOne Form Per Student, PleaseName *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeStudent BirthdateMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926Age in SeptemberParent/Guardian Name *Email AddressPhone *Parent/Guardian Name *Email AddressPhone *Emergency ContactPhone *Important Medical Information (ex: allergies)(Immunizations are not required, but strongly recommended that they be up to date)Classes are filled on first come, first serve basis. A space will be saved for your child when a completed registration form is received, along with a non-refundable $25 registration fee. Please notify us by August 15th if your child will not be attending, so we may fill their spot. If a class is full when we receive your registration, we will contact you. Otherwise, you will receive a letter in early August informing you of our Open House and class schedule.CLASSES (please make a selection)AM Class is always from 8:45-10:45 and PM Class is always from 11:15-1:15PRE-K (4 years turning 5 years/5 years turning 6 years)2 Day/Week AM Class - Monday & Wednesday 8:45 - 10:452 Day/Week PM Class - Monday & Wednesday 11:15-1:153-Day/Week Class - Monday & Wednesday AM or PM and Tuesday PM4-Day/Week Class - Monday & Wednesday AM or PM and Tuesday & Thursday PM3-4 Year Olds (3 years turning 4 years)1 Day/Week - either Tuesday or Thursday 8:45-10:452 Days/Week - Tuesday and Thursday 8:45-10:45Tuition *The tuition schedule for the upcoming year is as follows:1 Day - $80 2 Days - $100 3 Days - $120 4 Days - $140Those who pay in cash are offered a $5 discount/month.**Remember to enclose or complete your form and a $25 registration fee - Thank you!**Mail Completed Form To: The Crayon Academy, 217 Lyndale Lane, Butte, MT 59701 Contact Information: Heidi Grey (406) 498-9368 Lucy Hansen (406) 491-1961 Non-Refundable Registration Fee + Credit Card Processing FeeTotal Amount Due TodayWould you like to pay Registration fee now?YesCredit / Debit Card *$25 registration fee + Processing FeeSubmit enrollmentPlease do not fill in this field.
