2018-2019 Registration Form
Please complete ALL of the information in order to register your child for the 2018-2019 school year.

A $75 (per family) non-refundable deposit is due at registration. Classes are formed on a first come, first served basis, and are based on a minimum number of student enrollments. If a class does not fill and is canceled, we will refund your deposit.

All children must be fully potty trained by the beginning of the school year.

After completing this form, finalized registration will be depend on your submission of the 1) Registration Packet (separate from this form; please visit our registration webpage), 2) printed pages as indicated in this Google Form, and 3) Registration Fee to the Preschool office.

PLEASE HAVE A PRINTER AVAILABLE, AS YOU WILL NEED TO PRINT SOME PAGES.
YOU ONLY NEED TO PRINT THE PAGES WHERE YOU ARE INSTRUCTED--"PICK UP" PAGES AND "PERMISSIONS" PAGES.

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Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth (format 00/00/0000) *
Your answer
Age as of 9/5/18 (years AND months). Example: 3 years, 7 months *
Your answer
Gender *
FOR OFFICE USE ONLY: DATE ASQ GIVEN TO PARENT:
LEAVE THIS BLANK.
Your answer
Child's street address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Home phone or best cell phone # (format xxx-xxx-xxxx) *
Your answer
Does your child have any allergies for which the school will need to monitor symptoms? *
Does your child have any medical conditions for which the school will need to monitor symptoms or medications the school will or may need to administer? *
How did you learn about Shiloh Preschool?
For every family you refer who enrolls, you will earn a $25 tuition credit.
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