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Imagine School at Broward VPK (4 year olds) Pre-Registration Form
Please fill out the pre-registration form and we will contact you in regards to the next step in this process. For more information you may contact Cindy Brown at
cindy.brown@imagineschools.org
or 954-255-0020 x108.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Gender
*
Female
Male
Parent #1 First Name
*
Your answer
Parent #1 Last Name
*
Your answer
Parent #1 Telephone Number
*
Your answer
Parent #1 Email
*
Your answer
Parent #2 First Name
Your answer
Parent #2 Last Name
Your answer
Parent #2 Telephone Number
Your answer
Parent #2 Email
Your answer
Child's Home Street Addess
*
Your answer
Child's Home City
*
Your answer
Child's Home Zip Code
*
Your answer
Please rank your class choice: 1-2-3
*
Morning VPK 8:30 - 11:30 (free with state voucher
Afternoon VPK 12:30 - 3:30 (free with state voucher)
Full Time VPK 8:30 - 2:30 ($825/month with state voucher)
First Choice
Second Choice
Third Choice
Morning VPK 8:30 - 11:30 (free with state voucher
Afternoon VPK 12:30 - 3:30 (free with state voucher)
Full Time VPK 8:30 - 2:30 ($825/month with state voucher)
First Choice
Second Choice
Third Choice
Language(s) spoken at home
*
Your answer
Language(s) child speaks
*
Your answer
Does child have a sibling attending Imagine School at Broward? If yes, please list name of sibling(s).
Your answer
Please indicate if parent(s) is/are one of the following:
*
Staff Member
First Responder
Military
None of the above
Questions/Comments
Your answer
Send me a copy of my responses.
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