Kids' Safari Learning Center

Adventures in Learning

Please fill out this form to request enrollment at Kids’ Safari.

Parent/Guardian 1: *
Street Address *
City, State *
Zip Code *
Home Phone *
Cell Phone
Work Phone
Home Email
Work Email
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Parent/Guardian 2:
Street Address 2
City, State 2
Zip Code 2
Home Phone 2
Cell Phone 2
Work Phone 2
Home Email 2
Work Email 2
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Child 1 Name *
First Name M.I. Last Name
Date of Birth *
mm-dd-yyyy
Gender * Male Female
Program Requested *
*Part Day Preschool is offered Monday, Wednesday and Friday mornings. 8:45am – 11:45am (3yr and 4yr olds)
Schedule *
Requested Start Date *
mm-dd-yyyy
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Child 2 Name
First Name M.I. Last Name
Date of Birth 2
mm-dd-yyyy
Gender 2 Male Female
Program Requested 2
*Part Day Preschool is offered Monday, Wednesday and Friday mornings. 8:45am – 11:45am (3yr and 4yr olds)
Schedule 2
Requested Start Date 2
mm-dd-yyyy
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Medical Concerns/Allergies
Academic Concerns
Social Concerns
Other Concerns/Comments/Additional Children

Current Openings:
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207 Commerce Parkway
Cottage Grove, WI 53527
608-839-9095