Century Primary Preschool Registration
Please register your preschool child for the 2020-2021 school year. He/She must turn four-years-old by July 31, 2020.
Century Primary Elementary, 1542 School Road, Grafton, ND 58237, 701.352.1930
Preschool Child's Name (First, Middle, Last) *
Child's Date of Birth *
Mother's Name *
Father's Name *
Child's Home Address *
Mother's Email *
Father's Email *
Mother's Phone Number *
Father's Phone Number *
Do you prefer Morning or Afternoon Preschool *
Ethnicity - Hispanic or Latino *
Race *
Does your child qualify for either or both of the following: *
Has your child previously attended a preschool program? *
If your child previously attended preschool, please name the preschool (or city attended):
Does your child currently qualify for, or receive, special education services, including speech? *
My child qualifies for busing through his/her Individual Education Program (IEP): *
Do you have any concerns regarding your child's academic or behavioral development? Please explain or state no concerns: *
Medical - My child has a special diet or allergy. Please explain:
If available, I would be interested in busing to or from daycare: *
Please add any other information you feel would be beneficial in meeting the needs of your child:
I intend on sending my child to the Century Primary Preschool Program this fall: *
Parent Signature (typed name of person completing the form) *
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