2017/2018 Cold Springs Preschool Enrollment
Please fill out this form in it's entirety.

Cold Springs Preschool provides a high quality learning environment where each child is valued, while quipping each student with skills they need to be successful in the next stage of development. Each child is nurtured in an atmosphere which enhances him/her academically, socially, emotionally, physically and spiritually. We invite you to call and visit us and see our program in action any time. Children are a precious gift from God and we treasure the opportunity to be part of their lives.

Carol Hendry, Director
Cold Spring Preschool

Date of Enrollment: *
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Child's Full Name *
Your answer
Child's Date of Birth *
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Class Selection: *
Gender *
Child's Address: *
Your answer
Primary email address:
Your answer
Parent's Marital Status: *If divorced, a copy of the Divorce Order noting custodial arrangements must be provided to the preschool prior to starting school. *
Child lives with: *
Father/Guardian's Name: *
Your answer
Father/Guardian's Preferred method of contact: (Please provide at least one contact phone number.) *
Father/Guardian's Cell Phone #:
Your answer
Father/Guardian's Home Phone #:
Your answer
Father/Guardian's Work Phone #:
Your answer
Mother/Guardian's Name: *
Your answer
Mother/Guardian's Preferred method of contact: (Please provide at least one contact phone number.) *
Mother/Guardian's Cell Phone #:
Your answer
Mother/Guardian's Home Phone #:
Your answer
Mother/Guardian's Work Phone #:
Your answer
In case of emergency contact (First/Last name): *
Your answer
Emergency contact phone #: *
Your answer
In case of emergency contact (First/Last name):
Your answer
Emergency contact phone #:
Your answer
In case of emergency contact (First/Last name):
Your answer
Emergency contact phone #:
Your answer
Name of Child's Physician: *
Your answer
Physician's Phone #: *
Your answer
Name of Child's Dentist: *
Your answer
Dentist's Phone #: *
Your answer
I give my permission to my child's teacher or Preschool Director to authorize Emergency care for my child in the event: No family emergency contacts can be reached, the child's family physician can't be reached, or the Preschool staff deems the situation to be an emergency. *
My child has allergies: *
If yes, please indicate allergies below:
Will medical devices be provided to preschool? *
If yes, in case of emergency, my child will have the following medical devices at school provided by the parent/guardian:
Please list any illnesses that your child has had: *
Required
Immunizations and Tests: (We must have a copy from your child's physician) *
Required
Date of last physical exam: *
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Has your child had an eye exam? *
Has your child had a hearing test? *
Has your child been diagnosed with any medical conditions the preschool should be aware of? *
If yes, please indicate:
Your answer
Please let us know if you have any questions or would like to schedule a tour. Please contact the Director, Carol Hendry, at (704) 782-1875 or email: preschool@coldspringsumc.org
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