2025-2026 Preschool Registration Form

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Please complete the form below to enroll your child in preschool at River Valley for the 2025-2026 school year.

Email *

Child's First Name *

Child's Middle Name *

Child's Last Name *

Child's Date of Birth (MM/DD/YEAR) *

Place of Birth *

Child's Gender *

Female

Male

Mother's Name (First and Last) *

Mother's Age *

Mother's Address (include PO box if applicable) *

Mother's Phone Number *

Mother's Employer *

Father's Name(First and Last) *

Father's Age *

Father's Address (include PO box if applicable and different from mother)

Father's Phone Number *

Father's Employer *

Marital status of parents *

Married

Divorced

Live separately

Other:

Other members of the household (children, relatives, others) Please include name, age, and relationship

Any additional adults representing the child (Step parent, foster parent, legal guardian, etc)

Please complete the statement: My child's best characteristics are: *

Please complete the statement: My child has trouble with OR I am concerned about: *

Please complete the statement: I want my child to go to preschool in order to: *

Please mark all that apply to your preschool-aged child. Does your child... *

Have food allergies?

Have non-food allergies?

Use the restroom independently?

Get dressed independently?

Have difficulty hearing?

Have difficulty seeing?

Wear glasses?

Have physical or emotional problems?

Required

IF your child has food allergies, please tell us which foods your child is allergic too.

IF your child has any non-food allergies, please tells us what he/she is allergic to.

Please indicate your preference for Sunblock *

I would like my child to have sunblock applied to him/her before going outside for recess. I understand that I must provide the teacher with spray/lotion.

I would NOT like my child to have sunblock applied to him/her before recess.

Please indicate your preference for Insect Repellent *

I would like to have insect repellent applied to my child before recess. I understand that I will have to provide teachers with spray/lotion.

I would NOT like my child to have insect repellent applied to them before recess.

Parental Consent: Please check all items that apply to your child. By checking these boxes you consent to each item marked. *

I understand that I will be responsible for any tuition or fees that may be associated with my child attending River Valley Preschool. ($45/month beginning in Sept (extended day), $10 supply fee due at registration/first day of PK)

I understand that all paperwork (physical, immunization record, etc.) must be turned in by Sept. 10 for my child to attend preschool.

I understand that I need to report all absences and illnesses to my child's teacher before 8:30 am if my child will not be attending school.

My child may go on friend trips with the preschool class (ex. Pumpkin Patch, fire station, etc.). I understand that I will be notified before these trips take place.

My child's picture may be displayed in the newspaper.

My child's picture may be displayed on the school's website.

Required

Preschool Programming choice *

SVPP preschool--8:20-1:00 only (free)

Extended day programming-- 8:20-3:20 ($45/month fee)

Any additional comments/requests

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