Imlay City Preschool Application

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Please fill this form out completely. An Imlay City Preschool staff member will contact you to set up a follow-up appointment for you to sign the application, bring in the documentation and a $25 registration fee. Limited spots available. Subject to approval. This application is not considered complete until $25 deposit is received, all documentation is turned in, application is signed and you receive a welcome letter from Imlay City Preschool.

Our tuition preschool program has a limited number of spots available. For the best chance to reserve a spot for your child, it is important that you attend your follow-up appointment and turn all documentation in as soon as possible.

PLEASE NOTE: There is NOT AN OPTION TO SAVE an application and go back into it later. You will want to make sure you have the following information available when you fill out the application:
*Child's doctor's name and phone number
*Name and phone number for at least one emergency contact

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عنوان بريد إلكتروني *

Program Requested *

Please note: All our Preschool Programs run Monday - Thursday.

AM (3 Year Old Preschool) 8:50 - 11:50 AM *****Class is full. WAITLIST available.*****

PM (4 Year Old Preschool) 12:40 - 3:40 PM

FULL DAY (4 Year Old Preschool) 8:50 AM - 3:40 PM

Child's Full Name *

Gender *

Male

Female

Date of Birth *

شهر

YYYY

Child's Birthplace *

City, State, Country

Child's Home Address *

Number, Road, City, State, Zip Code

County of Residence *

Home School District *

Primary Phone *

Secondary Phone *

Email Address *

Birth Father's Name *

First & Last

Birth Mother's Name *

First & Last

Birth Parents are: *

Please check all that apply.

Together

Not Together

Married

Seperated

Divorced

أخرى:

مطلوب

Child lives with: *

Birth Father and Birth Mother

Birth Father

Birth Mother

Step Parent

Grand Parent(s)

Foster Parents

أخرى:

مطلوب

Where does child stay at night? *

in a home that we own/rent

in a hotel/motel

in a car

at a campsite

temporarily with another family in their house, mobile home or apartment

in a shelter

أخرى:

مطلوب

Race *

American Indian/Alaska

Asian/Asian American

Black/African American

Caucasian/White

Hawaiian/Pacific Islander

أخرى:

مطلوب

Hispanic or Latino *

Yes

Primary Language *

English

Spanish

أخرى:

Does your family migrate? *

Yes

If yes, approximate dates of migration?

Parent/Guardian Information

Father/Legal Guardian's Full Name *

First & Last

Father/Legal Guardian's Employer

Father/Legal Guardian's Occupation

Father/Legal Guardian's Employer Phone

Mother/Legal Guardian's Full Name *

First & Last

Mother/Legal Guardian's Employer

Mother/Legal Guardian's Occupation

Mother/Legal Guardian's Employer Phone

Siblings

Sibling#1 Name

First & Last

Sibling#1 Date of Birth

شهر

YYYY

Sibling#2 Name

First & Last

Sibling#2 Date of Birth

شهر

YYYY

Sibling#3 Name

First & Last

Sibling#3 Date of Birth

شهر

YYYY

Sibling#4 Name

First & Last

Sibling#4 Date of Birth

شهر

YYYY

Sibling#5 Name

First & Last

Sibling#5 Date of Birth

شهر

YYYY

Sibling#6 Name

First & Last

Sibling#6 Date of Birth

شهر

YYYY

Active US Military *

Yes

US Military Veteran *

Yes

Comments/Additional Information

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