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Mon/Wed Mini Miner Preschool
2020-21 Bingham High Preschool Registration Wait List
4 yr old Mon/Wed Class, 9:30-11:40
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Please verify that your child is currently 4 years old or will be 4 by September 1, 2020 and would like the Monday/Wednesday option. * (We cannot enroll students who are eligible for Kindergarten)
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My child will be 4 and I want the Mon/Weds class
My child is 3, but I would like to be put on the waitlist. If there is availability, then Mrs Dunn can add me to the list
CONTACT INFORMATION
Please fill in the following information
Child's First Name (As Shown on birth certificate)
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Your answer
Child's Preferred Name (Nick Name)
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Your answer
Child's Last Name
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Your answer
Child's Middle Name
Your answer
Child's Date of Birth (mm/dd/yyyy)
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Your answer
Ethnicity
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Your answer
Child's Gender
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Male
Female
Child's Preferred Language
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Your answer
Child's Home Address (as you would address an envelope)
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Your answer
Parent's Preferred Email Address (To send home reminders or preschool information)
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Your answer
Mother's First Name
Your answer
Mother's Last Name
Your answer
Mother's Cell Number
Your answer
Mother's Work Number
Your answer
Father's First Name
Your answer
Father's Last Name
Your answer
Father's Cell Number
Your answer
Father's Work Number
Your answer
In case of a custodial issue, please inform the Preschool Director and make a note on this record:
Your answer
Name of emergency contact:
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Your answer
Phone number of emergency contact:
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Your answer
Any food allergies?
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Yes
No
If YES, please list the food allergies
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Your answer
Additional registration agreements
In order for your child to be accepted into the Mini Miner Program, the following must be completed:
I understand that in addition to this registration form, I must pay the $40 nonrefundable registration fee to the Bingham High School Office to hold my child's spot in the Mini Miner Preschool.
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Yes
No
I understand that in addition to this registration form, I must provide a copy of an official birth certificate to the main office at Bingham High School before my child may attend the Mini Miner Preschool (Bring it in and we can make a copy)
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Yes
No
I understand that in addition to this registration form, I must also submit current immunization records or personal exemption form to the main office at Bingham High School before my child may attend the Mini Miner Preschool
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Yes
No
I understand that in addition to this registration form, I must also submit the district registration packet to the Bingham High Main Office (Packets won't be available until April- Mrs. Dunn will send out an email when they are available)
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Yes
No
Thank you for registering for the Mini Miner Preschool
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