Online Margaret Mace School Preschool Registration
Note:  Child must be 3 years old by September 30th with the following requirements:  Proof of Residency – 2 (Lease, current tax or utility bill);  Birth Certificate and Immunization Record and Custody papers or other legal papers. 
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Email Address: *
Student's Legal Name (Last Name, First Name, Middle Name) *
Parent/Guardian Name(s) (Last Name, First Name) *
Home Address (Street, City, Zip Code) *You will be required to provide proof of residency.* *
Cell Phone (Area Code and Number) *
Home Phone (Area Code and Number) *
Child's Date of Birth (Month/Day/Year) *
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/
DD
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YYYY
City, State and County of Birth *
Gender *
Ethnicity (Check all that apply.  Completion of this section is optional and is used for compliance with Federal and State reporting requirements.)
Child's Native Language *
Language spoken at home *
Child is living with (Check One)
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Pediatrician *
Please indicate any medical concerns for your child, including allergies. *
Please list any medications your child takes. *
Is your child toilet trained?
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List any other helpful information. *
Social-Emotional/Behavioral Skills (Check all that apply)
Yes
No
Sometimes
Hits others
Talks back
Verbally fights with others
Constantly seeks attention
Difficulty separating from parents
Takes turns/shares with others
Makes new friends easily
Adjusts to changes
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Check all that apply
If you checked any of the statements above please explain (all information obtained is confidential).
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