Imlay City Preschool Application
Please fill this form out completely. An Imlay City Preschool staff member will contact you to set up a follow-up appointment for you to sign the application, bring in the documentation and a $25 registration fee. Limited spots available. Subject to approval. This application is not considered complete until $25 deposit is received, all documentation is turned in, application is signed and you receive a welcome letter from Imlay City Preschool.

Our tuition preschool program has a limited number of spots available. For the best chance to reserve a spot for your child, it is important that you attend your follow-up appointment and turn all documentation in as soon as possible.

PLEASE NOTE: There is NOT AN OPTION TO SAVE an application and go back into it later. You will want to make sure you have the following information available when you fill out the application:
*Child's doctor's name and phone number
*Name and phone number for at least one emergency contact

Program Requested *
Please note: This is just a request, it is not guaranteed. 3 year olds are given preference to AM program.
If there was an option to send your child to full day tuition preschool, would this be something you would be interested in? *
Child's Full Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Child's Birthplace *
City, State, Country
Your answer
Child's Home Address *
Number, Road, City, State, Zip Code
Your answer
County of Residence *
Your answer
Home School District *
Your answer
Primary Phone *
Your answer
Secondary Phone *
Your answer
Email Address *
Your answer
Birth Father's Name *
First & Last
Your answer
Birth Mother's Name *
First & Last
Your answer
Birth Parents are: *
Please check all that apply.
Required
Child lives with: *
Required
Where does child stay at night? *
Required
Race *
Required
Hispanic or Latino *
Primary Language *
Does your family migrate? *
If yes, approximate dates of migration?
Your answer
Parent/Guardian Information
Father/Legal Guardian's Full Name *
First & Last
Your answer
Father/Legal Guardian's Employer
Your answer
Father/Legal Guardian's Occupation
Your answer
Father/Legal Guardian's Employer Phone
Your answer
Mother/Legal Guardian's Full Name *
First & Last
Your answer
Mother/Legal Guardian's Employer
Your answer
Mother/Legal Guardian's Occupation
Your answer
Mother/Legal Guardian's Employer Phone
Your answer
Siblings
Sibling#1 Name
First & Last
Your answer
Sibling#1 Date of Birth
MM
/
DD
/
YYYY
Sibling#2 Name
First & Last
Your answer
Sibling#2 Date of Birth
MM
/
DD
/
YYYY
Sibling#3 Name
First & Last
Your answer
Sibling#3 Date of Birth
MM
/
DD
/
YYYY
Sibling#4 Name
First & Last
Your answer
Sibling#4 Date of Birth
MM
/
DD
/
YYYY
Sibling#5 Name
First & Last
Your answer
Sibling#5 Date of Birth
MM
/
DD
/
YYYY
Sibling#6 Name
First & Last
Your answer
Sibling#6 Date of Birth
MM
/
DD
/
YYYY
Active US Military *
US Military Veteran *
Comments/Additional Information
Your answer
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