Little Wings of Atascadero Enrollment Form
Please fill out all of the following information and one of our Little Wings staff members will be in touch with you as soon as possible!
Child's Name? (First and Last) *
Child's Gender? *
Child's Date of Birth *
MM
/
DD
/
YYYY
1st Parent/Guardian's Name (First and Last) *
1st Parent/ Guardian's Email *
1st Parent/Guardian's Phone Number: *
2nd Parent/Caregiver Name (First, Last)
2nd Parent/Caregiver Phone Number:
2nd Parent/Caregiver Email:
Address *
Does your child currently have any developmental delays? Check all that apply:
Does your child have a diagnosis? (If yes, please list it)
Did/does your child receive early intervention services? *
Reason you want your child enrolled in our preschool?
Are you interested in Full-Time (8:00 am- 4:30pm) or Part-Time (8am-12pm)? *
Which Days of the Week Are You Looking to Enroll Your Child? *
Required
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