STAGES Intake – S.T.A.G.E.S of Learning Center

Parent's Name (required)

Name of Child (required)

Age of Child (required)

Family Email (required)

Best Contact Number (required)

I am interested in my child attending the Behavior Matters/STAGES preschool on...

I am interested in my child attending the Behavior Matters/STAGES Summer preschool Program on...

Who will pick up your child?

Parent/ GuardianSchool Bus

Snacks & Lunch will be eaten as a group, please list allergies

Are you a current Behavior Matters client?

YesNo

100 Mainstreet Center, Sydney

Phone:(208) 333 9296

Fax:(208) 333 9298

Open Monday – Friday 9:00am – 3:00pm