FACTS Confirmation Form

FACTS CONFIRMATION FORM

To reserve your child’s placement, please fill out the required information below including your family’s FACTS Agreement Number and confirming your child’s information.

Your tuition will be based on the information you provided.

Child's Name

First Name

Last Name

FACTS Agreement Number

Child's Birthdate

YYYY

Child's Schedule

(Select One)

Full Day

Half Day

Potty Trained

Fully Potty Trained (With No Accidents)

Not Potty Trained

Please Confirm Child's Start Date

YYYY

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone Number