ADMISSIONS

• Parent / Guardian Name*
• Street Address*
• City*
• State*
• Zip / Postal Code*
• Cell Phone*
• Home Phone
• Place of Work
• Email Address*
• First Child's Full Name*
• First Child's Date of Birth*
  Date Format: MM slash DD slash YYYY
• Second Child's Full Name
• Second Child's Date of Birth
  Date Format: MM slash DD slash YYYY
• Third Child's Full Name
• Third Child's Date of Birth
  Date Format: MM slash DD slash YYYY
• I'm interested in the Bright & Early located at*
  Select OneMiddletown, CTNiantic, CTNorth Branford, CTOld Saybrook, CTWest Hartford, CT
• I would like to:*
  Select OneSchedule a TourRequest Additional InfoI’m Ready to Enroll!
• Referred by
• Estimated Start Date for Enrollment*
• Desired Schedule*
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Before and/or After School
  • Summer Camp
• Comments
  This field is for validation purposes and should be left unchanged.

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