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<title>
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<form class="userform-form" action="" method="post" name="form_5763795" id="5763795" accept-charset="utf-8"><input type="hidden" name="formID" value="5763795" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_40" class="form-input-wide"> <div class="form-header-group"><h2 id="header_40" class="form-header">Registration for 2026-2027 is closed</h2></div> </li><li class="form-line" id="id_37"><div class="form-label-left" id="label_37"><label for="input_37"> I am interested in: </label><label class="label-message" for="input_37"> </label></div><div id="cid_37" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_37_0" name="q37_input37[]" value="18-24 Months" /><label id="label_input_37_0" for="input_37_0"><span>18-24 Months</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_37_1" name="q37_input37[]" value="2 year olds" /><label id="label_input_37_1" for="input_37_1"><span>2 year olds</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_37_2" name="q37_input37[]" value="3 year olds (existing families only!)" /><label id="label_input_37_2" for="input_37_2"><span>3 year olds (existing families only!)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_37_3" name="q37_input37[]" value="4 year olds (existing families only!)" /><label id="label_input_37_3" for="input_37_3"><span>4 year olds (existing families only!)</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_3" class="form-input-wide"> <div class="form-header-group"><h2 id="header_3" class="form-header">Student Information</h2></div> </li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Child's Name<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q4_fullName[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q4_fullName[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_6"><div class="form-label-left" id="label_6"><label for="input_6"> Child's Birth Date<span class="form-required">*</span> </label><label class="label-message" for="input_6"> </label></div><div id="cid_6" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate[month]" id="input_6_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_6_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate[day]" id="input_6_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_6_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q6_birthDate[year]" id="input_6_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_6_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Gender<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_7_0" name="q7_input7" value="Male" /><label id="label_input_7_0" for="input_7_0"><span>Male</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_7_1" name="q7_input7" value="Female" /><label id="label_input_7_1" for="input_7_1"><span>Female</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> Applying Parent's Name<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q8_fullName8[first]" id="first_8" autocomplete="given-name" />  <label class="form-sub-label" for="first_8" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q8_fullName8[last]" id="last_8" autocomplete="family-name" />  <label class="form-sub-label" for="last_8" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Address<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q9_address[addr_line1]" id="input_9_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_9_addr_line1" id="sublabel_9_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q9_address[addr_line2]" id="input_9_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_9_addr_line2" id="sublabel_9_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q9_address[city]" id="input_9_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_9_city" id="sublabel_9_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q9_address[state]" id="input_9_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_9_state" id="sublabel_9_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q9_address[postal]" id="input_9_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_9_postal" id="sublabel_9_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q9_address[country]" id="input_9_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and 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value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_9_country" id="sublabel_9_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_35"><div class="form-label-left" id="label_35"><label for="input_35"> Are you interested in: </label><label class="label-message" for="input_35"> </label></div><div id="cid_35" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_35_0" name="q35_input35[]" value="Half Day" /><label id="label_input_35_0" for="input_35_0"><span>Half Day</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_35_1" name="q35_input35[]" value="Full Day" /><label id="label_input_35_1" for="input_35_1"><span>Full Day</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_34"><div class="form-label-left" id="label_34"><label for="input_34"> I am interested in: </label><label class="label-message" for="input_34"> </label></div><div id="cid_34" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_34_0" name="q34_input34[]" value="Early care (8:00-8:30 AM)" /><label id="label_input_34_0" for="input_34_0"><span>Early care (8:00-8:30 AM)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_34_1" name="q34_input34[]" value="After care (3:30-5:00 PM)" /><label id="label_input_34_1" for="input_34_1"><span>After care (3:30-5:00 PM)</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_11" class="form-input-wide"> <div class="form-header-group"><h2 id="header_11" class="form-header">Parent Information</h2></div> </li><li id="cid_15" class="form-input-wide"> <div class="form-header-group"><h3 id="header_15" class="form-header">Parent #1</h3></div> </li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Parent's Name<span class="form-required">*</span> </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q12_fullName12[first]" id="first_12" autocomplete="given-name" />  <label class="form-sub-label" for="first_12" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q12_fullName12[last]" id="last_12" autocomplete="family-name" />  <label class="form-sub-label" for="last_12" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Parent's Cell Phone<span class="form-required">*</span> </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q14_phoneNumber[area]" id="input_14_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_14_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q14_phoneNumber[phone]" id="input_14_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_14_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Parent's E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_13" name="q13_email" size="30" value="" autocomplete="email" /> </div></li><li id="cid_16" class="form-input-wide"> <div class="form-header-group"><h3 id="header_16" class="form-header">Parent #2</h3></div> </li><li class="form-line" id="id_17"><div class="form-label-left" id="label_17"><label for="input_17"> Parent's Name<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q17_fullName17[first]" id="first_17" autocomplete="given-name" />  <label class="form-sub-label" for="first_17" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q17_fullName17[last]" id="last_17" autocomplete="family-name" />  <label class="form-sub-label" for="last_17" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Parent's Cell Phone<span class="form-required">*</span> </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q18_phoneNumber18[area]" id="input_18_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_18_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q18_phoneNumber18[phone]" id="input_18_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_18_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Is the mother of the child Jewish? <span class="form-required">*</span> </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_19_0" name="q19_input19" value="Yes" /><label id="label_input_19_0" for="input_19_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_19_1" name="q19_input19" value="No" /><label id="label_input_19_1" for="input_19_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Have there been any conversions in the family?<span class="form-required">*</span> </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_20_0" name="q20_input20" value="Yes" /><label id="label_input_20_0" for="input_20_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_20_1" name="q20_input20" value="No" /><label id="label_input_20_1" for="input_20_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_21" class="form-input-wide"> <div class="form-header-group"><h2 id="header_21" class="form-header">Additional Information</h2></div> </li><li class="form-line" id="id_38"><div class="form-label-left" id="label_38"><label for="input_38"> Will you be applying for financial aid? </label><label class="label-message" for="input_38"> </label></div><div id="cid_38" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_38_0" name="q38_input38[]" value="Yes" /><label id="label_input_38_0" for="input_38_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_38_1" name="q38_input38[]" value="No" /><label id="label_input_38_1" for="input_38_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_39"><div id="cid_39" class="form-input-wide"> <div id="text_39" class="form-html"><p>If you selected yes, please send an email to VillageJewishPreschool@gmail.com requesting the form to begin the process.</p>
</div> </div></li><li class="form-line" id="id_22"><div class="form-label-left" id="label_22"><label for="input_22"> Prefer to be contacted by </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_22_0" name="q22_input22[]" value="Email" /><label id="label_input_22_0" for="input_22_0"><span>Email</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_22_1" name="q22_input22[]" value="Phone" /><label id="label_input_22_1" for="input_22_1"><span>Phone</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_23"><div class="form-label-left" id="label_23"><label for="input_23"> How did you hear about us? </label><label class="label-message" for="input_23"> </label></div><div id="cid_23" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_23_0" name="q23_input23[]" value="Google" /><label id="label_input_23_0" for="input_23_0"><span>Google</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_23_1" name="q23_input23[]" value="Social Media" /><label id="label_input_23_1" for="input_23_1"><span>Social Media</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_23_2" name="q23_input23[]" value="Other online" /><label id="label_input_23_2" for="input_23_2"><span>Other online</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_23_3" name="q23_input23[]" value="Friend/Neighbor" /><label id="label_input_23_3" for="input_23_3"><span>Friend/Neighbor</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[other]" name="q23_input23[other]" id="other_23" value="" /><span><input type="text" class="form-checkbox-other-input form-textbox form-checkbox validate[other]" name="q23_input23[other][text]" data-otherhint="Other" size="15" id="input_23" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_29"><div id="cid_29" class="form-input-wide"> <div id="text_29" class="form-html"><p><input id="text_29" name="text_29" style="display:none" type="hidden" value="Double-click to edit this text..." /><input id="text_29___Config" style="display:none" type="hidden" value="" /></p>

<p><strong>There is a $500 registration fee .</strong></p>

<p><strong>Click <a href="/Article.asp?AID=5779640">here</a> to view our full tuition rates.</strong></p>

<p><strong>If you decide not to send your child to our school, your deposit will NOT be refunded</strong></p>

<p><strong>If your child is not accepted into our preschool, we will refund your deposit.</strong></p>

<p><strong>Please input your payment here for the registration fee:</strong></p>
</div> </div></li><li class="form-line" id="id_30"><div class="form-label-left" id="label_30"><label for="input_30"> Registration Fee<span class="form-required">*</span> </label><label class="label-message" for="input_30"> </label></div><div id="cid_30" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_30_0" name="q30_input30[]" checked="checked" value="$500" /><label id="label_input_30_0" for="input_30_0"><span>$500</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_31"><div class="form-label-left" id="label_31"><label for="input_31"> Total </label></div><div id="cid_31" class="form-input"> <div id="total_amount">$500.00 </div> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> Payment </label><label class="label-message" for="input_25"> </label></div><div id="cid_25" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q25_payment[cc_type]" id="input_25_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q25_payment[cc_number]" id="input_25_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_25_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q25_payment[cc_ccv]" id="input_25_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_25_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q25_payment[cc_nameOnCard]" id="input_25_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_25_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card "><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q25_payment[cc_exp_month]" id="input_25_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_25_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q25_payment[cc_exp_year]" id="input_25_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_25_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="billing_address "><th colspan="2">Billing Address</th></tr><tr class="billing_address "><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q25_payment[addr_line1]" id="input_25_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_25_addr_line1" id="sublabel_25_addr_line1">Street Address</label></span></td></tr><tr class="billing_address "><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" 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 /****************************************************************************************************
 * @name: LivIconsEvo.defaults.js - the default options for LivIcons (Live Icons) Evolution
 * @version: 2.3.XXX (XXX is a total number of icons)
 * @URL: https://livicons.com
 * @copyright: (c) 2013-2016 DeeThemes (http://codecanyon.net/user/DeeThemes)
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 *****************************************************************************************************/
 ;if (typeof jQuery === 'undefined') {
 throw new Error('LivIcons Evolution Script requires jQuery!');
 };
 
 function LivIconsEvoDefaults () {
 
 "use strict";
 
 var default_options = {
 
 pathToFolder: 'https://w2.chabad.org/images/mychabad/resources/click/Icons/', //the path from root of your site to folder with icons. Also may be as URL, like 'http://yoursite.com/path/to/LivIconsEvo/svg/'
 name: 'bell.svg', //the default icon name
 
 //visualization options
 
 style: 'original', //'original', 'solid', filled', 'lines' or ('lines-alt' / 'linesAlt')
 size: '60px', //default size
 
 strokeStyle: 'original', //'original', 'round' or 'square'
 strokeWidth: 'original', //'original' or any value in pixels
 
 tryToSharpen: true, //apply or not micro shifts of SVG shapes to try to make them more sharp (crisp)
 
 rotate: 'none', //'none' or any value in deg [0 ... 360]
 flipHorizontal: false,
 flipVertical: false,
 
 strokeColor: '#22A7F0', //when style opt is 'filled' or 'lines' or ('lines-alt' / 'linesAlt')
 strokeColorAction: '#b3421b', //when 'style' is 'original', 'filled' or 'lines' and 'colorsOnHover' or 'colorsWhenMorph' is 'custom'
 strokeColorAlt: '#F9B32F', //when style opt is ('lines-alt' / 'linesAlt')
 strokeColorAltAction: '#ab69c6', //when 'style' is ('lines-alt' / 'linesAlt') and 'colorsOnHover' or 'colorsWhenMorph' is 'custom'
 fillColor: '#91e9ff', //when style opt is 'filled'
 fillColorAction: '#ff926b', //when 'style' is 'original' or 'filled' and 'colorsOnHover' or 'colorsWhenMorph' is 'custom'
 solidColor: '#6C7A89', //when style opt is 'solid'
 solidColorAction: '#4C5A69', //when 'style' is 'solid' and 'colorsOnHover' or 'colorsWhenMorph' is 'custom'
 solidColorBg: '#ffffff', //when style opt is 'solid'
 solidColorBgAction: '#ffffff', //when 'style' is 'solid'
 
 colorsOnHover: 'none', //'none', 'lighter', 'darker', 'custom' or 'hue0' ... 'hue360'
 colorsHoverTime: 0.3, //seconds
 
 colorsWhenMorph: 'none', //'none', 'lighter', 'darker', 'custom' or 'hue0' ... 'hue360'
 
 brightness: 0.10, // brightness change when 'lighter' or 'darker' (10% by default)
 saturation: 0.07, // saturation change when 'lighter' or 'darker' (7% by default)
 
 morphState: 'start', //'start' or 'end' (initial state for animating position)
 morphImage: 'none', //'none' or a URL to your image (better to use an image with equal width and height)
 allowMorphImageTransform: false, //if true the inside image will rotate and/or flip with a morph icon together
 
 strokeWidthFactorOnHover: 'none', //'none' or numeric value. For ex., for increase twice set the option to 2
 strokeWidthOnHoverTime: 0.3, //seconds
 keepStrokeWidthOnResize: false,
 
 //animation options
 
 animated: true, //if false, an icon is static
 eventType: 'hover', //'click', 'hover' or 'none'
 eventOn: 'self', //'self', 'parent', 'grandparent' or any ID (#some_id) or class (.some_class)
 
 autoPlay: false, //be careful with true value
 delay: 0, //value in seconds
 duration: 'default', //'default' or value in seconds
 repeat: 'default', //'default', 'loop' or integer number of repeats
 repeatDelay: 'default', //'default' or value in seconds
 
 drawOnViewport: false,
 viewportShift: 'oneHalf', //'none', ('one-half' / 'oneHalf'), ('one-third' / 'oneThird') or 'full'
 drawDelay: 0, //seconds
 drawTime: 1, //seconds
 drawStagger: 0.1, //seconds
 drawStartPoint: 'middle', //'start', 'middle' or 'end'
 drawColor: 'same', //'same' or any desired color value (HEX)
 drawColorTime: 1, //seconds
 drawReversed: false, //true will reverse the order of shapes drawing
 drawEase: 'Power1.easeOut', //default ease
 
 eraseDelay: 0, //seconds
 eraseTime: 1, //seconds
 eraseStagger: 0.1, //seconds
 eraseStartPoint: 'middle', //'start', 'middle' or 'end'
 eraseReversed: true, //true will reverse the order of shapes erasing
 eraseEase: 'Power1.easeOut', //default ease
 
 touchEvents: false, //apply or not special events handlers for touch devices
 
 //callback functions
 
 beforeAdd: false,
 afterAdd: false,
 
 beforeUpdate: false,
 afterUpdate: false,
 
 beforeRemove: false,
 afterRemove: false,
 
 beforeDraw: false,
 afterDraw: false,
 duringDraw: false,
 
 beforeErase: false,
 afterErase: false,
 duringErase: false,
 
 beforeAnim: false,
 afterAnim: false,
 duringAnim: false
 };
 
 if (default_options.pathToFolder === '/EDIT THIS OPTION!/') {
 alert('LivIcons Evolution: Please edit "pathToFolder" option in the "LivIconsEvo.defaults.js" file!');
 throw new Error('LivIcons Evolution: Please edit "pathToFolder" option in the "LivIconsEvo.defaults.js" file!');
 };
 
 return default_options;
 };</script>
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