Busy Days Registration Form

Enrollment is Quick & Easy! (If you prefer to use a printable, mailable form, please use one of these links: Waunakee or Fitchburg.) Class availability is limited. Filled on a first-come, first-served basis. Minimum of 4 children needed to form a class. Please indicate your 1st, 2nd, and 3rd choices if possible. Summer class dates: Each session is 5 weeks long with 45-minute weekly classes. Parent/caregiver attends entire class. Waunakee: July 27 - August 28 Fitchburg: July 13 - August 21 (no class July 27-31). Registration Fee: $39 reserves your place and purchases your home materials. Home Materials include: Baby book; cage bell; home CD; and parent poster. NOTE: Non-refundable as your materials are purchased upon enrollment. Camp Tuition: $69 for 5 weeks. Payment plans available. Tuition not due until classes begin unless on payment plan. Total cost = Tuition + Registration
Child's Name: *
Child's Gender: *	Male Female
Child's Birthdate: *
Materials Needed: *	Require Full Home Materials (Required if never taken) Need Sibling Kit Only (Own partial materials only) Have Full Home Materials Kit (Must present to educator)
1st Class Choice: *
2nd Class Choice: *
3rd Class Choice: *
	Please check box if re-enrolling.
Does your child have any allergies or special needs? *	Yes No
If yes, please list all special needs or allergies of which we should be aware.
Parent's Name(s): *
E-mail: *
Home Phone: *
Cell Phone:
Work Phone:
Street Address: *
City/State/Zip: *
Adult Attending Class (if other than parent):
How did you hear about us?
Tuition Options	I would like to discuss tuition payment plans.
Busy Days Registration
	When you click the Submit button, you will be taken to a secure payment page. You will be able to pay the registration fee using your credit card or PayPal.