Preschool Registration 2018-2019
Child's Full Legal Name: *
Your answer
Nickname (What you would like your child to be called): *
Your answer
Child's Date of Birth: *
**Must be 4 by Sept. 15th, 2018
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Gender: *
Address & City: *
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Parent 1 Name: *
Your answer
Parent 1 Phone Number: *
Your answer
Parent 1 Occupation: *
Your answer
Parent 1 Email: *
** If no email please enter noemail@text.com
Your answer
Parent 2 Name: *
Your answer
Parent 2 Phone Number: *
Your answer
Parent 2 Occupation: *
Your answer
Parent 2 Email: *
** If no email please enter noemail@text.com
Your answer
Does this child have other siblings? If yes, what age/grade? *
Your answer
Preschool Preference: *
Preference given by first come first serve.
Previous preschool experience: *
Your answer
Please complete the following checklist about your child. *
Check all that describe your child.
Required
What is your child’s primary spoken language? *
Your answer
Are there other languages being used with your child? If so, what? *
Your answer
How did you hear about the Early Learning Center?
Your answer
Please describe your child’s strengths: *
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Please describe your child’s weaknesses: *
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What are your child’s interests? *
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How does your child interact with other children his/her age? *
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Why would you like your child to be enrolled as a peer model? *
Your answer
Is there any other information that you would like to share with us about your child?
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