Learning Seeds Registration Form
3 and 4 year old pre-school at Wilson Chapel Christian Union
Email
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Name of Student *
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Name student wants to be called *
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Date *
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Date of birth
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DD
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YYYY
With whom does student reside *
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Name of parents or guardians living with student *
Your answer
Address of parents or guardians living with student *
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Cell phone of parents or guardians living with student *
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Occupations of parents or guardians
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Please list any other family members in household and their ages.
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Do you have a home church that you attend?
What is the name of your home church?
Your answer
Does student have another parent that is NOT living in the same house hold?
Will this parent be involved in transportation or tuition payments?
Name of parent not living in household (only if applicable)
Your answer
Address of parent NOT living in house hold (if applicable)
Your answer
Phone # of parent NOT living in house hold (if applicable)
Your answer
Does your student have any special needs that teachers should be aware of?
example; emotional, physical or social
Your answer
Please choose the class you will be enrollong in. *
Student must be class age by September 1st of the upcoming school year.
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