Terrier P.U.P.S. Pop-Up Preschool Registration

We are excited to begin offering Terrier P.U.P.S.—a free, play-based learning opportunity for children ages 3–5 who are not currently enrolled in a Pre-K program. Terrier P.U.P.S. helps children build kindergarten readiness skills through hands-on activities, parent engagement, and a supportive environment.

Only 20 spots are available, so please complete this registration form to reserve your child’s spot. 

  • If we exceed 20 registrations, we will place additional families on a waitlist and contact you if a spot becomes available.
  • We require active parent/caregiver participation throughout the session, so plan to stay with your child the entire time.
Please fill out the form below to reserve your spot or join the waitlist.
Sign in to Google to save your progress. Learn more
Child's Information
Child's name and birthdate (must be between3-5)
 *
Parent/Caregiver's Information
Caregiver's name
 *
Parent/Caregiver's Contact Information
Caregiver's email address
 *
Parent/Caregiver's Contact Information
Caregiver's phone number
 *
School District Eligibility (you must live in the Carbondale Community High School District #165, including local feeder schools) *
Enrollment Status (is your child currently enrolled in a Pre-K program?) *
Allergies or Special Accommodations (Please list any allergies, dietary restrictions, or other needs.)  
  Caregiver Participation Agreement   *
Required
  Additional Comments (Optional)   (Is there anything else you would like us to know?)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Carbondale Public Library.

Does this form look suspicious? Report

Google Forms