Preschool Wed Night Registration
For children who are at least 4 yrs old by 7-31-20 and not yet in Kdg
Child Information
Child's First Name *
Child's Last Name *
Date of Birth (must be 4 by 7-31-20) *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip *
Parent/Guardian Information
Parent/Guardian First Name(s) *
Parent/Guardian Last Name *
Parent/Guardian Email *
Primary Phone Number *
Secondary Phone Number *
Emergency Contact Info (other than parent/guardian)
Emergency Contact Name *
Relationship to Child *
Emergency Contact Phone Number *
Miscellaneous Information
Allergies, medical conditions or anything else you would like us to be aware of:
*
Required
*
Required
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