2020-2021 Centreville Preschool Inc. Enrollment Application

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Instructions:
1. Complete this form.
2. After clicking Submit, visit https://tinyurl.com/cpi-parent-20 to download the CPI Policies, Membership Agreement, and Parent Acknowledgement page. Print, fill out and sign the Parent Acknowledgement page.
3. The registration fee is $65.00. Please make checks payable to CPI and write your child's name in the Memo line. (Just one registration fee per family!)
4. Mail (via U.S. Postal Service ONLY) the Parent Signature page along with your $65 check to: Enrollment Director, Centreville Preschool, Inc. PO Box 253, Centreville, VA 20122

IMPORTANT: You MUST mail in BOTH items -- (1) Parent Acknowledgement page AND (2) $65 registration fee -- for your application to be marked complete and begin processing. Your application will be processed based on the POSTMARK DATE of these items, not the date you submit this online application form. We will not process your child's application If you fail to send these items.

5. Students enrolling after the school year begins are required to pay May 2021 tuition, one-time supply fee, and prorated current month's tuition before they may start classes.

Child’s First Name *

Child’s Last Name *

Name to be called in school

Birthdate *

YYYY

Gender *

Female

Male

Is your child currently enrolled at CPI? *

Yes

If Yes, in which class?

If No, how did you hear about us? (Check any that apply)

My child is the sibling or child of another current student or CPI alumni.

I've heard great things about CPI from friends and neighbors!

I found you on Facebook.

I found your website / read about you online.

Other:

CPI alumni/student name (if applicable)

Name of person who referred you to CPI (if applicable)

Optional: Student's Ethnicity/Race (Check all that apply)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Optional: Is this student Hispanic or Latino?

No, not Hispanic or Latino

Yes

Home Street Address *

Home City, State ZIP *

Primary Phone Number *

Father’s Name *

Father’s Email Address *

Father’s Employer *

Father’s Work Phone

Father’s Cell Phone *

Mother’s Name *

Mother’s Email Address *

Mother's Employer *

Mother's Work Phone

Mother's Cell Phone *

List any other email addresses that should receive school communications.

May we publish your cell phone number(s) on our Parent Class Roster (only distributed to other parents of children in your child’s class)? *

Yes

Please provide names and date of birth for any younger children for CPI’s alumni list:

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