KINDERGARTEN REGISTRATION SURVEY
My child will be 5 years old by December 1, 2019
Child’s Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Street Address
Your answer
City, State and Zip
Your answer
Daytime Phone #
Your answer
Evening Phone #
Your answer
Cell Phone #
Your answer
Babysitter/Pre-School
Your answer
Guardian #1 Name
Your answer
Guardian #2 Name
Your answer
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