Preschool Registration 2021-2022
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Child's Full Legal Name: *
Nickname (What you would like your child to be called): *
Child's Date of Birth: *
**Must be 4 by Sept. 15th, 2021
Gender: *
Race *
Ethnicity *
Address & City: *
Parent 1 Legal Name: *
Parent 1 Phone Number: *
Parent 1 Occupation: *
Parent 1 Email: *
** If no email please enter
Parent 2 Legal Name: *
Parent 2 Phone Number: *
Parent 2 Occupation: *
Parent 2 Email: *
** If no email please enter
Does this child have other siblings? If yes, what age/grade? *
Preschool Preference: *
Preference given by first come first serve.
Previous preschool experience: *
What is your child’s primary spoken language? *
Are there other languages being used with your child? If so, what? *
How did you hear about the Early Learning Center?
Please describe your child’s strengths: *
Please describe your child’s weaknesses: *
What are your child’s interests? *
How does your child interact with other children his/her age? *
Why would you like your child to be enrolled as a peer model? *
Is there any other information that you would like to share with us about your child?
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