*Please check the class for which your child is applying: (Birthdate by Sept 1st) *
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** Please note that the full school year price includes a 2.5% discount for paying in full at the time of first payment by the first day of school.
Child's Name *
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Nickname
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Child's birthdate *
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DD
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YYYY
Street Address, Town, Zip Code *
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Father's Name
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Father's e-mail
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Father's Home Phone Number
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Father's Cell. Phone Number
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Father's Work Phone Number
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Father's Street Address (*if different)
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Mother's Name
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Mother's e-mail
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Mother's Home Phone Number
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Mother's Cell. Phone Number
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Mother's Work Phone Number
Your answer
Mother's Street Address (*if different)
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Child's Physician and Phone Number
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*If we are unable to reach a parent in an emergency, is there someone else we could contact? (Grandparent/friend/neighbor) *
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Emergency Contact Phone Number *
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*Other Members of Household: List Name / Age / Relationship
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*Does your child have any special needs of which we should be aware of? (Physical limitations, allergy, speech, behavior, family history) Briefly explain:
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*What do you hope your child will gain from this preschool experience?
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*How did you hear about Kiddy City Preschool?
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*Does your family currently attend a church?
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*Questions you might have about our preschool program?
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As we anticipate the start of preschool we would like to have a headshot picture of your child. This will help to familiarize us with each student who will be coming in September. Please send this picture with your application. Thank you! PARENT SIGNATURE & DATE *
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** Application is not complete until a $30 Registration Fee (Non-refundable) is received **Make checks payable to Mohn’s Hill EC Church (Please write your child’s name on check) Mail $30 Registration Fee to: Kiddy City Preschool @ Mohn’s Hill EC Church 708 Mohn’s Hill Road Reading, PA 19608