Pre-Registration Form
Pre-Register for Bend Preschool
Parent 1: First and Last Name *
Parent 1: Address *
Parent 1: Phone Number *
Cell Carrier *
Parent 1: Email Address *
Parent 2: First and Last Name
Parent 2: Address
Parent 2: Phone Number
Cell Phone Carrier
Parent 2: Email Address
Who do you know (past or present) that has attended our schools? *
How did you hear about Bend Preschool? *
If this is a personal referral, who referred you (otherwise enter N/A)? *
I have applied for FREE Preschool through the link at www.bendpreschool.com/free-preschool/ (student must be 36 mo by 9/1/21 and not older than 5 years by the same date- not eligible for Kindergarten). *
Student 1: First and Last Name *
Student 1: Date of Birth (children under 18 mo not accepted at this time, application will be discarded for children under 18 months) *
Days of the Week Needed *
Required
Drop off and Pick up Hours *
Required
Pick up hours *
Required
Location requested (Pilot Butte or Galveston) *
Date care is needed *
MM
/
DD
/
YYYY
Student 2: First and Last Name *
Student 2: Date of Birth (children under 18 mo not accepted at this time, application will be discarded for children under 18 months) *
Where is your family currently enrolled? *
In this section please let us know any details about your child, special requests or any additional questions you might have. *
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