Bellaire Local Preschool Registration Form

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Due to many factors that impact the number of children we are able to accept in our preschool program, we are not able to guarantee a spot in the preschool classroom until all of the registration processes have been completed. We look forward to meeting you and your child.

Students must be 3 years of age before August 1, 2020, and must not turn 5 years old before August 1, 2020 (kindergarten age)

Email *

District of Residence *

Bellaire Local

Other:

Required

Student First Name *

Student Last Name *

Gender *

Male

Female

Date of Birth *

YYYY

Parent/Guardian Full Name *

Street Address *

City *

State *

Zip Code *

Cell Phone *

If you do not have a cell phone, please enter NA as the answer

Home Phone *

If you do not have a home phone, pelase enter NA as the answer

Birth City *

Ares of Concern *

Please check all that apply

No concerns

Speech/Language

Self-Help Skills

Thinking Skills

Motor Skills

Social Behavior

Required

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

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