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First Presbyterian Preschool Summer School Registration
Please submit this form to reserve your spot.
Checks can be mailed to or dropped off at:
First Presbyterian Church
Attn: First Presbyterian Preschool
3401 N. Valparaiso St.
Valparaiso, IN 46383
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Email
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Class Preference
Summer School - 9 AM-11 AM - Monday, July 29 - Friday, August 2 -$100
Child's Full Name
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Prefers to Be Called
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Sex
Male
Female
Other:
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Address with City, State, Zip
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Home Phone
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Cell Phone
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Date of Birth
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Email Address
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How did you hear about our preschool?
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Fathers Name/Occupation/Place of Business
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Mother's Name/Occupation/Place of Business
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Name(s) of Legal Guardian(s)
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Child Resides With
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Emergency Phone Numbers
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Name and age of Siblings
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Who is allowed to pick up your child from school? (Names/Relation to child/phone numbers)
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Are there others living in the house?
Yes
No
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If yes, what is their relationship to child?
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Physician's Name and Phone Number
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In case of an emergency, will you allow the teacher to call an ambulance?
Yes
No
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Should your child's physical activities be limited in any way?
Yes
No
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If yes, explain
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Does your child have any food restrictions or general allergies?
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No
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Please describe in detail (severity/treatment).
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Describe here any physical or behavior problems of which we should be aware.
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Are parent's members of a church?
Yes
No
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If yes, what church? (Mother and Father)
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Has your child attended Church School?
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No
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Where?
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What does your child particularly like to do?
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What does your child dislike doing?
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Does your child have any specific fears?
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What do you expect from PWNS for your child?
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Other comments/information you wish to share.
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A copy of your responses will be emailed to the address you provided.
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