2021-2022 Smart Start Preschool Registration
Student Information
Child's Full Name: *
Birthdate: *
MM
/
DD
/
YYYY
Gender: *
Street Address: *
City: *
State: *
Zipcode: *
Father's Name: *
Phone: *
Work phone: *
Cell Phone: *
Mother's Name: *
Phone: *
Work Phone: *
Cell Phone: *
Family Email: *
Child Resides with: *
Required
Class Options
*Students must be of age by September 1 of enrolling school year and toilet trained.*
*Depending upon enrollment numbers, we may combine into one MWF class if we don't have enough kids enrolled in both classes.*
Check Desired Class: *
Financial assistance is available through Ellsworth Public School for those that qualify. Funds are limited.
Bussing Options *
Registration Deadline- June 1st
$25 registration fee (if registered by June 1st)
$35 registration fee (if registered after June 1st)

Tuition: $60/month (T/TH)
Tuition: $90/month (M/W/F)
Please send completed form and registration fee to: (checks payable to Ellsworth Public School)
Ellsworth Public School
P.O. Box 8
Ellsworth, MN 56129
507-967-2242
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