CPC Pre-Registration Form 2019
Complete all questions and submit to register.
Child's Full Name: *
Your answer
Date of Birth (please click the down arrow that appears when hovering over mm/dd/yyyy and use the calendar to select): *
MM
/
DD
/
YYYY
Gender: *
Parent /Guardian Name (First & Last): *
Your answer
Parent/Guardian Contact Phone Number: *
Your answer
Address: *
Your answer
Email:
Your answer
Please indicate preference (check all that apply) *
Required
1. Fees for Preschool are dependent upon state eligibility for services. 2. Corbin Preschool Center will be contacting you regarding a screening date for your child and additional program information. 3. Class time preference will be considered, but is not guaranteed.(please select "I understand" to acknowledge these statements.) *
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