2019-2020 Preschool Screening Signup
Student Last Name *
Your answer
Student First Name *
Your answer
Student Date of Birth *
Student must be four years old before August 1, 2019
MM
/
DD
/
YYYY
Student Gender *
Parent First and Last Name *
Your answer
Email Address *
Your answer
Home Phone Number:
Your answer
Cell Phone Number: *
Your answer
Street Address *
Example: 218 W. McCabe Street
Your answer
City, State, Zip *
Example: Strafford, MO 65757
Your answer
Do you prefer morning or afternoon class? *
*Students will be assigned to a time on a first come, first serve basis. We are unable to guarantee morning or afternoon placement until class lists are made.
Please bring the following items with you at time of screening: *
By checking the box next to each item, I understand I am required to bring these items with me on the day of screening.
Required
Time Slot Signup *
After submitting this form, your registration will not be complete until using the link provided on the confirmation page to sign up for a specific date and time for your child's screening.
Required
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