Pre-K Registration 2017-18
Pre-K Hours: 8:10-11:10 Monday-Friday
Daycare Hours: 11:10-5:30 Monday-Friday (separate from pre-k)
Student Full Name *
Your answer
Date of Birth *
Your answer
Male/Female *
Required
Child Lives With
Your answer
Mother's Name
Your answer
Address
Your answer
Home Phone
Your answer
Email
Your answer
Employer
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Father's Name
Your answer
Address *if different from mother's address
Your answer
Home Phone *if different from mother
Your answer
Employer
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Will child ride the bus?
My child will be picked up by:
Your answer
My Child will walk (with who):
Your answer
My child will attend church on Wednesdays after school:
Medical (Please list any allergies, special medical or dietary needs, or other concerns)
Your answer
Please select 3 dates & times you would be available for a home visit
Tuesday, August 1st
Wednesday, August 2nd
Thursday, August 3rd
9am-10am
10am-11am
11am-12pm
12-1pm
1pm-2pm
2pm-3pm
3pm-4pm
4pm-5pm
5pm-6pm
6pm-7pm
Submit
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