2018-2019 Centreville Preschool Inc. Enrollment Application
Instructions:
1. Complete this form.
2. After clicking Submit, visit https://tinyurl.com/cpi-parent-2018 to download the CPI Policies, Membership Agreement, and Parent Acknowledgement page. Print, fill out and sign the Parent Acknowledgement page.
3. The registration fee is $65.00. Please make checks payable to CPI, Inc. and write your child's name in the Memo line. (Just one registration fee per family!)
4. Mail (via U.S. Postal Service ONLY) the Parent Signature page along with your $65 check to: Enrollment Director, Centreville Preschool, Inc. PO Box 253, Centreville, VA 20122

IMPORTANT: You MUST mail in BOTH items -- (1) Parent Acknowledgement page AND (2) $65 registration fee -- for your application to be marked complete and begin processing. Your application will be processed based on the POSTMARK DATE of these items, not the date you submit this online application form. We will not process your child's application If you fail to send these items.

Child’s First Name *
Your answer
Child’s Last Name *
Your answer
Name to be called in school
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender *
Is your child currently enrolled at CPI? *
If Yes, in which class?
Your answer
If No, how did you hear about us? (Check any that apply)
CPI alumni/student name (if applicable)
Your answer
Name of person who referred you to CPI (if applicable)
Your answer
Optional: Student's Ethnicity/Race (Check all that apply)
Optional: Is this student Hispanic or Latino?
Home Street Address *
Your answer
Home City, State ZIP *
Your answer
Primary Phone Number *
Your answer
Father’s Name *
Your answer
Father’s Email Address *
Your answer
Father’s Employer *
Your answer
Father’s Work Phone
Your answer
Father’s Cell Phone *
Your answer
Mother’s Name *
Your answer
Mother’s Email Address *
Your answer
Mother's Employer *
Your answer
Mother's Work Phone
Your answer
Mother's Cell Phone *
Your answer
List any other email addresses that should receive school communications.
Your answer
May we publish your cell phone number(s) on our Parent Class Roster (only distributed to other parents of children in your child’s class)? *
Please provide names and date of birth for any younger children for CPI’s alumni list:
Your answer
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