Rockville High School Nursery School
Welcome to the Rockville High School Nursery School

To register your child, please complete this form.

Please remember criteria for entrance to the RHS Nursery School
      1. Child must be 3-5 years of age
      2. Child must be fully toilet trained

At this time schools are planning to open as usual in the fall. Preschool will begin November 10. This date is subject to change. Nursery schools hours will be Wednesdays, Thursdays, and Fridays from 9:30-11:30. These times are also subject to change.

Please complete this application if you wish for you child to attend the Rockville High School Nursery School. Once I receive your application I will send you either an email or letter informing you if you've been accepted or wait-listed. More information will be provided in these letters.

At Nursery School, it is our mission to ensure that all children feel welcomed and safe.  In order to support this mission, there are times when we provide hugs or high fives to children.  We may also give a "pat on the back" to affirm good work or to offer reassurance.  Additionally to ensure each child's safety, there are times when we may need to hold a child's hand, to support them in slowing their bodies down to avoid harming themselves, and to ensure each child's safety as they navigate new social relationships with peers.  

By completing this registration form, you are providing consent for us to provide these "hands-on" methods to ensure the happiness and safety of all children in our program.  Please know that if there is a situation where we must support your child in a "hands-on" manner to ensure their safety, we will inform you immediately with details of the situation.

Please note that the last three questions of this form are for OFFICE USE ONLY.  PLEASE LEAVE THE ANSWERS BLANK.
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Email *
Child's Last Name *
Child's First Name *
Gender *
Name we should call your child when attending school, OR if name is unique, please provide us with phonetic pronunciation. *
Child's Date of Birth (month/day/year) ex. 5/18/2013 *
What age will your child be as of November 1 *
Kindergarten Target Year *
Future School *
Parent/Guardian Information
Parent/Guardian # 1 Last Name *
Parent/Guardian # 1 First Name *
Parent/Guardian # 1 Street Address *
Parent/Guardian # 1 City *
Parent/Guardian # 1 State *
Parent/Guardian # 1 Zip Code *
Parent/Guardian # 1 Home Phone *
Parent/Guardian # 1 Cell Phone *
Parent/Guardian # 1 E-Mail Address *
Parent/Guardian # 1 Occupation/Company/Work Experience *
Parent/Guardian # 1 Work Phone *
Parent/Guardian # 2 Last Name *
Parent/Guardian # 2 First Name *
Parent/Guardian # 2 Street Address *
Parent/Guardian # 2 City *
Parent/Guardian # 2 State *
Parent/Guardian # 2 Zip Code *
Parent/Guardian # 2 Home Phone *
Parent/Guardian # 2 Cell Phone *
Parent/Guardian # 2 E-Mail Address *
Parent/Guardian # 2 Occupation/Company/Work Experience *
Parent/Guardian # 2 Work Phone
Names, Gender, and Ages of Siblings of Child
What languages are spoken in your home? *
What is the primary language spoken at home? *
Additional Information about Child
List any experiences your child has outside of the home with other groups of children that met on a regular basis (e.g. weekly playgroups, recreation department programs, church, nursery, etc.) *
If your child has a disability, is there a specific way a situation should be handled?
List your child's favorite activites *
Does your child need to know exactly what the routine will be that day, nearly to the minute? *
Describe your child's personality *
Is there any information that we should be aware of which will ease your child's adjustment to the center? *
Is there anything else we need to know about your child?
At the preschool, we like to take photos of the children for both educational purposes to show future students examples of certain types of learning as well as for our newsletter, RHS Instagram page, and our end-of-year slideshow. All photos are taken following Board of Education policy. Please let us know your decision about photos: *
If you answered "maybe" in the question above, please clarify:
For Office Use Only:  Did they Pay?
Clear selection
For Office Use Only: Did they Provide Health Forms?
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For Office Use Only: Did They receive Flu Immunization?
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A copy of your responses will be emailed to the address you provided.
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