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2022-2023 Preschool Application
Little Angels Preschool - Shelby County Catholic School - 2005 College Place, Harlan, Iowa 712-755-5634
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* Indicates required question
Child's Name (first, middle, & last)
*
Your answer
Child's Date of Birth (must be 4 years old by September 15th, 2022.)
*
MM
/
DD
/
YYYY
Child's Place of Birth
*
Your answer
Names of Parents/Guardians
*
Your answer
Please mark the child's ethnicity
*
American Indian/Alaskan Native
Asian
Black, African American
Hawaiian/Pacific Islander
Hispanic/Latino
White/Caucasian
Other
Mother's Address
*
Your answer
Mother's Cell Phone Number
*
Your answer
Mother's Work Place and Work Phone Number
*
Your answer
Father's Address (If different from mother's)
Your answer
Father's Cell Phone Number
Your answer
Father's Work Place and Work Phone Number
Your answer
Other Children in Household (Names, Dates of Birth, and Relationship to Child). If there are no other children in the household please reply "NA" or "Not Applicable."
*
Your answer
Email Address 1
Your answer
Email Address 2
Your answer
Has your child attended preschool prior to the 2021-2022 School year?
*
Yes
No
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