Imagine School at Broward VPK (4 year olds) Pre-Registration Form

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Please fill out the pre-registration form and we will contact you in regards to the next step in this process. For more information you may contact Hester van Rooyen at hester.vanrooyen@imagineschoolatbroward.org or 954-255-0020 x108.

Email *

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Child's Gender *

Female

Male

Parent #1 First Name *

Parent #1 Last Name *

Parent #1 Telephone Number *

Parent #1 Email *

Parent #2 First Name

Parent #2 Last Name

Parent #2 Telephone Number

Parent #2 Email

Child's Home Street Addess *

Child's Home City *

Child's Home Zip Code *

Please rank your class choice: 1-2-3 *

Morning VPK 8:30 - 11:30 (free with state voucher

Full Time VPK 8:30 - 2:30 ($825/month with state voucher)

First Choice

Second Choice

Language(s) spoken at home *

Language(s) child speaks *

Does child have a sibling attending Imagine School at Broward? If yes, please list name of sibling(s).

Please indicate if parent(s) is/are one of the following: *

Staff Member

First Responder

Military

None of the above

Questions/Comments

Send me a copy of my responses.

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