Church Street Preschool Enrollment Application
September 2018- June 2019
CHILD INFORMATION
Child's Name (First, M., Last) *
Your answer
Preferred Name
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Home Address *
Your answer
Mailing Address (if different than residence)
Your answer
Preferred Email Address *
Your answer
Child has a tendency to use: *
Fears
Your answer
Favorite Play Materials
Your answer
Prior Preschool/Group Experiences
Your answer
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