Loomis Community Preschool - Application For Enrollment {2018-19}
6414 Brace Road, Loomis, California 95650
loomispreschool.com
License #310-300416

Children are accepted without regard to race, color, religion, or national origin.

This application and a non-refundable $75 registration fee are required to secure your child's spot in the class. You can pay via Paypal at the end of this application, or by check. Thank you!

Child's Name (Last, First) *
Your answer
Select one: *
Child's Age *
Your answer
Child's Sex *
Birthdate *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Telephone (000-000-0000) *
Your answer
Does your child have any health problems or disabilities? *
Your answer
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