2020-2021 ACC PRESCHOOL REGISTRATION FORM
Currently registering for WAITLIST ONLY due to smaller class sizes required this year. If you are interested in learning more about our preschool program or scheduling a tour please call Elizabeth Young, Preschool Director, at 317-849-3957 or emailing at preschool@allisonville.org. Completing the registration form below will reserve your child's placement for the 2020-2021 school year once the Activity Fee is paid.
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Email *
Student Name *
Student Birth Date *
MM
/
DD
/
YYYY
Class Selection *
Required
Raindrops/Moonbeams Only - Select Preferred Days
Parent 1 Name *
Phone number for Parent 1 (xxx-xxx-xxxx) *
Email  for Parent 1 *
Parent 2 Name
Phone number for Parent 2
Email for Parent 2
Child's Primary Address *
City *
Zip Code *
Child lives with: *
Required
Siblings and ages:
School District child will attend: *
Religious Affiliation (if applicable):
Any thing special to know? (allergies, disabilities, fears)
Non-Parent Emergency Contact 1 Name & Relationship (Please list at least one person that does not reside with you like a grandparent, neighbor, friend etc.) *
Emergency Contact 1 Phone Number *
Non Parent Emergency Contact 2 Name & Relationship
Emergency Contact 2 Phone Number
Child's Doctor
Child's Doctor Phone Number
In the event none of the above persons can be reached, I give my permission for my child to be transported to the hospital indicated:
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