Copper Cubs Preschool 2018 - 2019 Preschool Registration for Tuesday/Thursday
Contact Information
Child's First Name *
As shown on birth certificate
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Nick Name
(If applicable)
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Child's Home Address *
As you would address an envelope
Your answer
Parent's Home Number
(If applicable)
Your answer
Parent's Preferred Email Address *
Your answer
Mother's First Name *
Your answer
Mother's Last Name *
Your answer
Mother's Cell Number *
Your answer
Mother's Work Number
(If applicable)
Your answer
Father's First Name *
Your answer
Father's Last Name *
Your answer
Father's Cell Number *
Your answer
Father's Work Number
(If applicable)
Your answer
Person(s) to Contact if Parents/Guardians are Unavailable
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
Special Information (Food allergies, etc.) *
If there is no special information, answer N/A or none
Your answer
I understand that I must also provide a copy of current immunization records or personal exemption form *
This can be brought with you to the Preschool Parent Meeting
I understand that I must provide a copy of an official birth certificate *
This can be brought with you to the Preschool Parent Meeting
I understand that there is a $25 registration fee and that it must be paid to guarantee a spot for my child in preschool *
This can be paid in the Copper Hills High School Main Office and it is non-refundable
I understand that I must also provide a (small) picture of my child. *
This can be a copy of a photo, sent by email (to sherrie.eloff@jordandistrict.org), and/or can be brought with you to the Preschool Parent Meeting.
Submit
Never submit passwords through Google Forms.
This form was created inside of Jordandistrict.org. Report Abuse - Terms of Service - Additional Terms