Little Pirate Roundup Pre-Registration Form
If you are interested in early childhood education opportunities for your child please fill out the form below and press submit. Thank you.
Child's Last Name (as shown on birth certificate) *
Your answer
First Name(as shown on birth certificate) *
Your answer
Date of Birth *
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YYYY
Gender
Street Address *
Your answer
City *
Your answer
Zip Code
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Parent/Guardian Names (First and Last) *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address *
Your answer
Program your family is interested in information about (click all that apply):
Lil' Pirate Roundup is Wednesday April 20th from 5-7 PM in the cafeteria. Join us to explore the programs that will be available for preschool and kindergarten children ages 3-6 at Peck Schools in the fall of 2016.
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