Check One

  2012 - 2013 Registration

Name of Child:_____________________________________

Name of Parents:__________________________________

Address:_________________________________________

Phone number:____________________________________

E-mail address: ___________________________________

Date of Birth:______________Age in August:____

Class to enroll: Circle your class session and time below / AM or PM

• 3 Year Old Preschool: T and TH : AM or PM  
• 4 Year Old Preschool : M/W/F : AM or PM  
• Pre-Kindergarten Class: M thru F :  AM or PM
• Please complete this form for each child you would like to enroll and return with your $60 ($30 for each additional child) registration fee made payable to:

The Little Light Learning Center

34201 Eddy Road

Willoughby Hills, OH 44094

Attention: Mrs. Trish Skrjanc

You will receive a receipt and confirmation of registration to keep for your records.

Tuition due the first of every month made payable in 9 monthly installments.

Printing Options:

-Choose "print preview" from the file menu and select the correct page.

-Copy and paste the registration form information into a word processing document.