Early Education Programs | Programs & Registration | Dates & Info | Parenting Info | Donate

Preschool - 5th Grade
Summer Discovery Days 2010

Please submit one form per child.

Have you been with us before?*	Current Family Former Family New Family
Grade Completed by June 6, 2010*	-- Please Select One -- Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
Child's Birthday*	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Gender*	Boy Girl
Child's Name*	First: Middle: (optional) Last
Name to be used at school
Child's Address*
City, State, zip*	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Parent/Guardian Information
Parent/Guardian Name*	First Name: Last Name:
Relationship to Child*	Please Select Mother Father Step Mother Step Father Aunt Uncle Family Friend Foster Parent Grandmother Grandfather Legal Guardian
Parent/Guardian Occupation
Parent/Guardian E-mail*
Parent/Guardian Home Phone
Parent/Guardian Cell Phone For Emergency Contact
Place of Business
Business Phone For Emergency Contact
Additional Parent/Guardian Information
Parent/Guardian Name	First Name: Last Name:
Relationship to Child	Please Select Mother Father Step Mother Step Father Aunt Uncle Family Friend Foster Parent Grandmother Grandfather Legal Guardian
Occupation
E-mail
Home Address If different from Child's Address
City, State, Zip	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Home Phone
Cell Phone For Emergency Contact
Place of Business
Business Phone For Emergency Contact
Additional Information
Names & Ages of Siblings
Additional Information that would help us know your child better or meet your scheduling needs.
Where did you hear about our program?	Web Lincoln Kids Free Times Word-of-mouth
Payment*	ACH Payment (Withdrawn from Checking or Savings) Payments will be withdrawn from your account on the 10th or the 25th of the month prior to the sessions for which you are registered. Check (Summer Only) If paying by check, payment for all summer sessions is due by May 15th.
Optional Sponsor a Child	I (We) would like to contribute an extra $10 each month to help a child who needs financial assistance. (This is a tax-deductible contribution). Thank You.
Session Information
Limited Early Morning Session (Available from 7:30 - 9:15 AM) What time do you wish to bring your child?
	Monday Tuesday Wednesday Thursday Friday I am flexible with these times. No Yes
Sessions*   9-11:30 AM 9-3:30 PM June 1-4: Limited Session for children currently enrolled in Dimensions Preschool for 2009-2010 $42 $103 June 7-11: The Wonders of Nature $52 $129 June 14-18: Art Works $52 $129 June 21-25: Buildings, Bridges, & Blocks $52 $129 June 28-July2: In the Dark! $52 $129 July 6-9 (Closed July 5): Imagine the Possibilities $42 $103 July 12-16: Nature Connections $52 $129 July 26-30: Inspired by Art $52 $129 August 2-6: Get in the Games $52 $129 Times before 9AM and after 3:30 PM will be charged at $3.90 per hour.
Afternoon Session (Available until 5:30 PM) Designed to extend the 9-3:30 session. Do you want your child to take a nap? No Yes (Preschool only) What time do you wish to pick up your child?
	Monday Tuesday Wednesday Thursday Friday I am flexible with these times. No Yes
A non-refundable Registration Fee of $15.00 is due now. Please send to: Dimensions, 2045 E Street, Lincoln, NE 68510

Confirmations, invoices, and forms will be emailed after April 9. We will call you if a spot is not available.

Note: Fields marked by an asterisk (*) are required.