Copper Cubs Preschool 2019 - 2020 Preschool Pre - Registration for Monday/Wednesday
Please verify that your child is currently 4 years old or will be 4 by September 1, 2019 and you would like them to be in the Monday/Wednesday class *
Contact Information
Child's First Name *
As shown on their Birth Certificate
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Child's Home Address *
Your answer
Parent's Home Number
(If applicable)
Your answer
Parent's Preferred Email Address *
Your answer
Mother's First and Last Name *
Your answer
Mother's Phone Number *
Your answer
Mother's Work Number
If applicable
Your answer
Father's First and Last Name *
Your answer
Father's Phone Number *
Your answer
Father's Work Number
If applicable
Your answer
Emergency Contact Information
Person(s) to contact if parents are not available
Emergency Contact #1 First and Last Name *
Your answer
Emergency Contact #1 Relationship to Child *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 First and Last Name *
Your answer
Emergency Contact #2 Relationship to Child *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Special Information
Any special information we should know about your child. If there is no special information, answer N/A
Special Information (Food allergies, etc.) *
Any special information we should know about your child. If there is no special information, answer N/A
Your answer
Additional Registration Information
In order for your child to attend Copper Cubs Preschool, the following must be completed:
I understand that in addition to this form, I must also fill out the Jordan School District Registration Packet *
District packets are not currently available. Please check back on the Copper Hills High School website as they will be available there (http://copperhillshigh.org/works/daycarepreschool/). When available, hard copies of this packet will be in the Copper Hills High Main Office.
I understand that in addition to this registration form, I must pay the $40 (non-refundable) registration fee in order to hold my child's spot in Copper Cubs Preschool *
This needs be paid in the Copper Hills High School Main Office within 1 week of the date of registration to hold your child's place in preschool. This fee is non-refundable.
I understand that in addition to this form, I must also provide a copy of my child's current immunization records or personal exemption form *
In addition to this form, I understand that I must provide my child's original birth certificate *
You will need to provide your child's original birth certificate for us to make a copy of
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