Heart Home Preschool Enrollment Questionnaire
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Email *
Parents Name (First & Last) *
Phone Number *
Phone number including area code
Child's Full Name  *
Child Is A *
Child's Date of Birth *
MM
/
DD
/
YYYY
Full or Part-Time? *
Days needed? *
Required
Hours needed? *
Is your child potty trained? (being potty trained is not a requirement for enrollment) *
Requested start date: *
MM
/
DD
/
YYYY
Has your child been in daycare previously?  *
Does your child have any allergies, special needs or dietary restrictions?  *
Tell me about your child. 
(Interests, nap schedule, favorite and least favorite foods, anything else you would like us to know.) 
 *

Please select "Yes" below to acknowledge that this form does not guarantee your child's placement in our preschool. You will be contacted to schedule a meet-and-greet as part of the enrollment process. Additionally, you acknowledge that participation in our preschool includes the required use of our cargo bike for outdoor learning and field trips.

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