Homer 33C Community Preschool 2020/2021 SY
Please know that completing this registration form does not guarantee placement in this program. This will be determined by the number of spaces that are available. You will be contacted when you have been accepted into the program. If you have any questions contact our district office at 708-226-7649
Email address *
Student Last Name (as it appears on birth certificate) *
Your answer
Student First Name (as it appears on birth certificate) *
Your answer
Student Middle Name
Your answer
Student Gender *
Student Date of Birth *
MM
/
DD
/
YYYY
Student is toliet trained *
Have any siblings attended or are currently enrolled in any Homer 33C Pre-K class or service *
Siblings Name and Age
Your answer
Is a language other than English spoken in your home *
If yes what language
Your answer
Does your child speak a language other than English *
If yes, what language
Your answer
Has your child had any preschool experience? *
Please include pre-school and daycare experience
Which schools or daycares?
Please include pre-school and daycare.
Your answer
Is your child eligible/receiveing any special education services? *
If yes, what services?
Your answer
Primary Household Information:
Student Home Address: *
Your answer
City *
Your answer
Zip: *
Your answer
Home School *
Home Phone: *
Use the Following Format: 999-999-9999
Your answer
Cell Phone: *
Use the Following Format: 999-999-9999
Your answer
Parent/Gauardian Information
Parent/Guardian 1. Name: *
Your answer
e-mail address: *
Your answer
Parent/Guardian 2. Name
Your answer
e-mail address:
Your answer
Parent/Guardian 2.Cell Phone
Your answer
Submit
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