Online Registation Form

Fill out the form below to submit your registration online.  Please note that we cannot guarantee start dates and enrollment is based on availability.

Registration fee is $80 for the first child and $40 for any additional children.  A $35 fee is required for all waitlist registrations.  (Balance of registration fee will be due upon enrollment confirmation.)  These fees are non-refundable under any circumstances.  One month security deposit is required upon enrollment.  Find out more about our program details here.

If you need immediate assistance, please call us at 914-271-0021.

Thank you for choosing Happy Hearts for your childcare needs!

* indicates required field

Person submitting form: *

Your email: *

Child's Name:

Birthdate: *

Sex:,M;F *

Mother's Name: *

Mother's Address: *

Mother's Home Phone:

Mother's Employer:

Mother's Business Phone:

Mother's Cell Phone: *

Father's Name: *

Father's Address: *

Father's Home Phone:

Father's Employer:

Father's Business Phone:

Father's Cell Phone: *

Emergency Contact (other than parent) Name: *

Emergency Contact Phone: *

Doctor's Name: *

Doctor's Phone: *

Conditions requiring special attention: (medial limitations, allergies, special needs)

Program, Infant (3M-18M); Toddler(18M-36M);Preschool(3-5yrs); Before/After School(5-8yrs) *

Requested Days: *

Mon
Tues
Wed
Thurs
Fri
Breakfast Club (6:30-8am) (extra)
Lunch Club(extra)

Requested Start Date*:

How did you hear about us?

Other information or questions?

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