Hannah Cole Preschool Enrollment 2021-2022
Please fill out this survey as part of your child's preschool enrollment. Child must be 3 by August 1st to enroll.
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Child's Name (First,Middle and Last Name) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Hispanic *
Race *
Name of Parent/Guardian *
Relationship to Child *
Address *
Home Phone/Cell Phone *
E-mail Address *
Spouse's Name
Relationship to child
Spouse's Cell Phone number
Emergency Contact #1 - Name (Person other than parent) *
Emergency Contact - Phone number *
Relationship *
Emergency Contact #2 - Name (Person other than parent)
Emergency Contact #2 - Phone Number *
Relationship *
Has your child ever been enrolled in Parents as Teachers *
Has your child ever been medically diagnosed as:
Please check all that are applicable to your child's household
Please check any area below in which you have a concern for your child.  Leave blank if you have no concerns.  
If you indicated an area of concern above please explain what that concern or concerns are.  
Please share  any other information about your child you feel it is important for us to know.
Schedule Your Appointment
Please contact Hannah Cole Primary to set up a time to bring in the following documents:  Birth Certificate, Immunization Record, Proof of Residency (utility bill, phone bill, lease agreement).   We will need these documents to complete the enrollment of your child.
Hannah Cole Primary  882-2744
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