2023-2024 Preschool Registration
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Email *
Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Date of Birth (MM/DD/YYYY) *
Child's Place of Birth *
Child's Gender *
Mother's Name (First and Last) *
Mother's Age *
Mother's Address (include PO box if applicable) *
Mother's Phone Number *
Mother's Employer *
Father's Name(First and Last) *
Father's Age *
Father's Address (include PO box if applicable and different from mother)
Father's Phone Number *
Father's Employer *
Marital status of parents *
Other members of the household (children, relatives, others) Please include name, age, and relationship
Any additional adults representing the child (Step parent, foster parent, legal guardian, etc)
Please complete the statement: My child's best characteristics are: *
Please complete the statement: My child has trouble with OR I am concerned about: *
Please complete the statement: I want my child to go to preschool in order to: *
Please mark all that apply to your preschool-aged child. Does your child... *
Required
IF your child has food allergies, please tell us which foods your child is allergic too.
IF your child has any non-food allergies, please tells us what he/she is allergic to.
Please indicate your preference for Sunblock *
Please indicate your preference for Insect Repellent *
Parental Consent: Please check all items that apply to your child.  By checking these boxes you consent to each item marked. *
Required
Preschool Programming choice *
Any additional comments/requests
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