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Application for Enrollment 
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Student's Full Name
Student's Preferred Name 
Gender 
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Birth Date 
MM
/
DD
/
YYYY
Check Only One (State Requirement) 
Student's First Language 
Language(s) Spoken at Home
Does Your Child Have Any Allergies? 
Does Your Child Have Any Special Needs or a Formal Diagnosis? 
Do You Have Any Concerns Regarding Your Child's Development? (Ex. Behavioral, Language, Motor, Cognitive)
Has Your Child Attended Another Preschool Before? 
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If Yes, Please Specify 
Preschool Class Choices (Please Select a first and second choice for class days/times.) 
Type 1st and 2nd Choice Class Options 
Father/Step-Father/Guardian Living With Full Name
Relationship to Student
Home Address (include city, state, zip)
Home Phone
Cell Phone
Work Phone
Occupation
Employer
E-Mail (Used for school correspondence)
Check All That Apply 
Mother/Step-Mother/Guardian Living With Full Name 
Relationship to Student 
Home Address (include city, state, zip)
Home Phone 
Cell Phone
Work Phone
Occupation 
Employer 
E-Mail (Used for school correspondence) 
Check All That Apply 
Emergency and Authorization to Release Information 
Persons to contact in case of illness or emergency and parent/guardian cannot be reached. I authorize the staff of The Children's Garden Preschool to contact the following local individuals and allow them to pick up my child from school. (Please provide at least two emergency contacts): 
Emergency Contact Number 1 (Please include name, daytime phone, cell phone, and relationship to student): 
Emergency Contact Number 2 (Please include name, daytime phone, cell phone, and relationship to student): 
Emergency Contact Number 3 (Please include name, daytime phone, cell phone, and relationship to student): 
Non-Emergency Adults Authorized to Release My Child To (Must be 12 years and older): 
Contact Number 1 (Please include name, daytime phone, cell phone, and relationship to student): 
Contact Number 2 (Please include name, daytime phone, cell phone, and relationship to student): 
Immediate Family Members or Anyone NOT Authorized to Pick Up Your Child From School
Please make sure to briefly explain in the description 
Include: Name, daytime phone, cell phone, relationship, and a brief description 
Include: Name, daytime phone, cell phone, relationship, and a brief description 
Non-Discrimination 
The Children's Garden Preschool will not discriminate in relation to admissions of any child on the basis of race, creed, color, national origin, religion, sex, or disability. The Children's Garden Preschool cannot guarantee a student's eligibility for continued enrollment after his or her initial admittance. The Children's Garden Preschool reserves the right to dismiss students based on its policies and regulations mentioned in the handbook not being followed. 
I Have Read the Terms Stated Above, and I Agree
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I have read the parent handbook and agree to follow the policies and procedures that are written. I also understand if any of the policies or procedures are broken, my child may be unenrolled from the preschool. 
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