Lighthouse Academy Registration Child’s Name Date Of Birth Street Address City ZIP Parent’s Name Email Phone 708 E. Veterans Parkway • Yorkville, IL.14959 Van Dyke Road • Plainfield, IL.153 Wright Street • Elburn IL12850 IL-47 • Huntley IL Start Date Please select the days your child will attend: MTWThF InfantToddlerTwosPreschoolPre-KLil Scholars Preschool KindergartenBefore & After School Subject Your message (optional) Mail/Deliver To: 708 E. Veterans Parkway • Yorkville, IL. 14959 Van Dyke Road • Plainfield, IL. 153 Wright Street • Elburn IL 12850 IL-47 • Huntley IL