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Holland Township School Preschool Lottery
Please complete before March 1, 2022
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* Indicates required question
Student's Name
*
Your answer
Is the student a resident of Holland Township?
*
Yes
No
Date of Birth:
*
MM
/
DD
/
YYYY
Age as of October 1st:
*
Your answer
Program Preference 1st choice:
AM
PM
Full day
Clear selection
Program Preference 2nd choice:
AM
PM
Full day
Clear selection
Home Address:
*
Your answer
Mother’s/Guardian Name:
Your answer
Address:
Same as child
Other:
Clear selection
Cell #:
Your answer
Email:
Your answer
Father’s/Guardian Name:
Your answer
Address:
Same as child
Other:
Clear selection
Cell #:
Your answer
Email:
Your answer
Submit
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