Debbie's Place Preschool Registration Form

12112 NE 66th St. Kirkland, WA 98033 

(425) 753-0052 (

TO RESERVE A SPACE FOR YOUR CHILD PLEASE COMPLETE THIS FORM along with a $100 non-refundable registration fee. The first tuition payment for Fall 2024 is due by Sept. 1st.

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Child's Name *
First and last name
Name you wish used
Date of Birth *
Age as of September 2024
Parent/Guardian Name(s) *
Cell Phone Numbers *
Address *
Email *
Siblings and Ages (if applicable)
Previous Preschool or Group Experience *
Where, or from whom, did you hear about Debbie’s Place Preschool?
Elementary school you will most likely attend
Emergency Contact #1 and Phone Number
Emergency Contact #2 and Phone Number (if applicable)
Persons allowed to pick up your child *
Allergies (if applicable)
Doctor's name and phone *
Anything special you'd like me to know about your child
For which class are you applying? *
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