Welcome to the UCiC School & Learning Center Enrollment Request Form (Bothell)

Child

Child First Name *

Child Last Name *

What is your child's birthday? * +

What program are you looking to join? *

Infant (6 Weeks - 12 Months)

Waddler (12 - 18 Months)

Toddler (18 - 36 Months)

Preschool 4-Hour (3 years old by Aug. 31st)

Preschool Full-Time (3 years old by Aug. 31st)

Pre-K 4-Hour (4 years old by Aug. 31st)

Pre-K Full-Time (4 years old by Aug. 31st)

Elementary (K-5th)

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email Address *

Emergency Pickup only

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Email Address *