Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

###

####

Student Birthdate *

MM

DD

YYYY

Is this child potty trained? *

If the student does not need consistent reminders to use the restroom, the majority of the time and does not have consistent accidents, we consider them fully potty trained.

Si

No

We have started potty training

Semester/s of Interest *

Fall 2024

Spring 2025

Summer 2025

Fall 2025

Spring 2026