23-24 Medina UPK/K Application
Please complete the information below to receive more information and a registration packet for the UPK and K programs (as appropriate) at Medina CSD.

**Please note, applications for UPK received after 3PM on Monday 4/3/23 may be subject to placement on a waiting list if capacity limits have been reached. Please call the Oak Orchard Main Office at 585-798-2700, options 3 and then 0 for more information. 
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Email *
How old will your child be by 12/1/23?

** If your child ALREADY attends UPK at Oak Orchard, you DO NOT need to complete an application.
 *
Child's first name *
Child's last name *
Gender *
Child's Birthdate *
MM
/
DD
/
YYYY
Child Lives With *
1st Parent/Guardian's first and last name *
1st Parent/Guardian's Phone Number with Area Code *
2nd Parent/Guardian's first and last name (optional)
2nd Parent/Guardian's Phone Number with Area Code
List an additional Parent/Guardian's first and last names and phone numbers here (optional)
Home Street Address (Information will be mailed here) *
City *
State *
Zip Code *
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