2020-2021 Preschool Registration
Email address *
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth (MM/DD/YYYY) *
Your answer
Child's Place of Birth *
Your answer
Child's Gender *
Mother's Name (First and Last) *
Your answer
Mother's Age *
Your answer
Mother's Address (include PO box if applicable) *
Your answer
Mother's Phone Number *
Your answer
Mother's Employer *
Your answer
Father's Name(First and Last) *
Your answer
Father's Age *
Your answer
Father's Address (include PO box if applicable and different from mother)
Your answer
Father's Phone Number *
Your answer
Father's Employer *
Your answer
Marital status of parents *
Other members of the household (children, relatives, others) Please include name, age, and relationship
Your answer
Any additional adults representing the child (Step parent, foster parent, legal guardian, etc)
Your answer
Please complete the statement: My child's best characteristics are: *
Your answer
Please complete the statement: My child has trouble with OR I am concerned about: *
Your answer
Please complete the statement: I want my child to go to preschool in order to: *
Your answer
Please mark all that apply to your preschool-aged child. Does your child... *
Required
IF your child has food allergies, please tell us which foods your child is allergic too.
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IF your child has any non-food allergies, please tells us what he/she is allergic to.
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Please indicate your preference for Sunblock *
Please indicate your preference for Insect Repellent *
Parental Consent: Please check all items that apply to your child. By checking these boxes you consent to each item marked. *
Required
Preschool Programming choice *
Any additional comments/requests
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