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Nelsonville-York Preschool Registration
2020-2021
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* Indicates required question
Email
*
Your email
Student's Last Name, First Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian Lastname, First Name Mother
*
Your answer
Parent/Guardian Lastname, First Name Father
*
Your answer
Home Phone Number (Include Area Code)
*
Your answer
Cellphone Number (Include Area Code)
*
Your answer
Home Address (Address Number and Street Only in this field)
*
Your answer
City, State, Zip Code
*
Your answer
School District of Residence
*
Your answer
Name of Previous Child Care
*
Your answer
Date of Last Well Check
*
MM
/
DD
/
YYYY
Total Number in Household
*
Your answer
Estimated Income 2019
*
Your answer
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