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Country Days Preschool Enrollment Requests
Please fill out this form to get your child on our waitlist
* Indicates required question
Child's Information
First and Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
Gender
*
Female
Male
Prefer not to say
Expected Start Date
*
MM
/
DD
/
YYYY
Class Attendance Days
*
Monday/Wednesday/Friday
Tuesday/Thursday
Required
Class Attendance Times
*
Morning
Afternoon
Required
Potty Training
*
Potty training complete
Interested in potty training
Not yet interested in potty training
Additional Information Regarding Attendance
Your answer
Parent/Guardian 1 Information
First and Last Name
*
Your answer
Email
*
Your answer
Relationship
*
Mother, Father, etc
Your answer
Mobile Phone Number
*
Please enter a valid phone number
Your answer
Address
Same as child
Other:
Clear selection
Parent/Guardian 2 Information
First and Last Name
Your answer
Email
Your answer
Relationship
Your answer
Mobile Phone Number
Your answer
Address
Same as child
Other:
Clear selection
Emergency Contact 1
First and Last Name
*
Your answer
Mobile Phone Number
*
Your answer
Emergency Contact 2
First and Last Name
*
Your answer
Mobile Phone Number
*
Your answer
Additional Information You Would Like Us to Know
Your answer
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