2023-2024 Preschool Pre-Registration

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Please fill out all following questions.

Email *

Child's Name *

Child's Date of Birth *

YYYY

Parent Name, Address & Phone Number *

Primary Language Spoken *

Please check any of the developmental concerns, which pertain to your child to help us identify any special needs, which may affect their ability to participate in the classroom. *

Social/Emotional (ie. not able to: Solve Problems, Interact with Others, Manage Emotions)

Self Help (ie. not able to: Use the bathroom independently, Assist in Dressing, Drink from a Cup)

Speech/Language (ie not able to: Talk, Follow Given Directions, Understand your Child's Speech)

Physical (ie. not able to: Walk, Jump, Run, Hold Crayon/Pencil)

Cognitive (ie. not able to: Stay on Task, Engage in Play, Attempt to Sing/Count Along w/ an Adult)

None

Required

Please mark below that you understand the purpose of completing this form is to: 1)Indicate your interest in your child participating in the DC West Preschool Program 2)Share your contact information and 3)Share any developmental concerns you have for your child. In addition, you acknowledge the completion of this form does NOT guarantee your child will be placed in the preschool program at DC West. *

I understand/acklowledge.

Required

A copy of your responses will be emailed to the address you provided.

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