Baltic School District Preschool Program

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2022-2023 Registration Form (See letter with specific information about all aspects of our pre-school)

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Child's Gender

Male

Female

Clear selection

Child resides

in the Baltic School District

Outside of the Baltic School District

Unsure

Clear selection

Preference ( This is NOT a guarantee, but we will accommodate as best we can.) *

Morning Session (Mon-Thurs)

Afternoon Session (Mon- Thurs)

No Preference (Mon-Thurs)

Transportation (See letter for specific transportation information) *

I will provide transportation for my child both to and from preschool.

I would like my child to ride the school bus to the morning session or home from the afternoon session.

I would have my child participate in district provided transportation to or from an in-town daycare, and understand there would be a fee for such transportation

Required

My child would need to be picked up or dropped off at

Home (out-of-town only, in-town has pickup points)

Daycare (in-town only)

Clear selection

Please indicate requested pickup and/or drop-off address

For families residing within the Baltic City limits, the bus will not make individual stops, but rather there will be 4-5 pick-up and drop off points. We will use the information provided below to establish those pickup or drop-off points.

Will your child be eating school breakfast and or lunch (for non-Headstart, for the current meal price)?

Check all that apply

Yes, Breakfast (morning session only)

Yes, Lunch (morning session only)

Parent/Guardian #1 First and Last Name: *

Parent/Guardian #1 relationship to child: *

Parent/Guardian #1 Address: *

Parent/Guardian #1 Cell Phone: *

Parent/Guardian #1 Email: *

Parent/Guardian #1 Home Phone:

Parent/Guardian #2 First and Last Name:

Parent/Guardian #2 relationship to child: *

Parent/Guardian #2 Address:

Parent/Guardian #2 Cell Phone:

Parent/Guardian #2 Email:

Parent/Guardian #2 Home Phone:

Emergency Contact #1 First and Last Name: *

Please provide 2 emergency contacts that you give permission to pick up your child and or notify if parent/guardian cannot be reached.

Emergency Contact #1 Address: *

Emergency Contact #1 Phone Number: *

Emergency Contact #1 Relationship: *

Emergency Contact #2 First and Last Name:

Emergency Contact #2 Address:

Emergency Contact #2 Phone Number:

Emergency Contact #2 Relationship:

Headstart Information

I have completed a Headstart application and my child qualifies for Headstart.

I have completed a Headstart application and my child does not qualify for Headstart.

I have not completed a Headstart application but intend to do so.

I have not completed a Headstart application and have no intention to do so.

Submit

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