Half Day Play Preschool Registration
Colonial Park United Church of Christ (5000 Devonshire Road, Harrisburg, PA 17109)  717-545-3782
        If you are registering online:  Send your $35 registration fee (check payable to HDP) w/Child's name in
        memo to above address.
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Child's Last Name *
Child's First Name *
Child's Middle Initial
Name Accustomed to being called?
Gender *
Birth date *
MM
/
DD
/
YYYY
Age on September 1 *
I prefer my child old to be in
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Mother's Name
Mother's Cell Phone (with area code ###-###-####)
Mother's Email Address
Father's Name
Father's Cell Phone (with area code ###-###-####)
Father's Email Address
Home Phone (with area code ###-###-####)
Address
City
Zip code
How did you hear about Half Day Play
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Emergency Contact Name & Phone  (with area code ###-###-####)
Family Physician Name & Phone  (with area code ###-###-####)
Is there anything you feel we should know about your child such as Allergies, Medications, Behavioral Issues (Explain below)
Submit
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