Barnum Preschool Registration
2020-2021 Preschool Registration, for questions, please email Roxy at rolsen@isd91.org.
Child's Full Name *
Child's Date of Birth
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DD
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Chose your class *
Address *
Parent/Guardian #1 Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Email Address *
Parent/Guardian #1 Place of work *
Parent/Guardian #1 Work Phone Number *
Parent/Guardian #2 Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email
Parent/Guardian #2 Place of Work
Parent/Guardian #2 Work Phone Number
My child has the following medical concerns/allergies:
Child Doctor and Contact Info *
Child Dentist and Contact Info *
IN THE EVENT OF ILLNESS OR INJURY TO MY CHILD AND WE CANNOT BE REACHED PLEASE CONTACT the following 2-3 people: (Name/relationship/phone number) *
Payment Option for the $50 non-refundable deposit: *
Thank you for registering for Fall 2020-2021 Preschool with Barnum Community Education. We will email you the rest of the forms upon receiving your payment.
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