Playtime registration form
Please bring payment ($80), cash or check, to your first class. Thank you!
Fall Playtime at St. Peter Nursery School begins Friday, January 10!
Child's Full Name *
Your answer
Name child goes by
Your answer
Gender
Date of birth
MM
/
DD
/
YYYY
Street address
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Mother's full name
Your answer
Mother's phone #
Your answer
Mother's email address
Your answer
Father's full name
Your answer
Father's phone #
Your answer
Father's email address
Your answer
Adult usually attending *
Your answer
Please list siblings and ages
Your answer
Any medical concerns or allergies?
Your answer
Please list any additional information that you think we should know (i.e. special needs, child's fears, etc.)
Your answer
Please list preferred class time
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