PRESCHOOL Application

Child's Name *
Child's Name
Child's D.O.B. *
Child's D.O.B.
Confirm Location *
Parent/Guardian *
Parent/Guardian
#1
Home Address *
Home Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Business address
Business address
Business phone
Business phone
Parent/Guardian *
Parent/Guardian
#2
Home address
Home address
If different from above
Home Phone
Home Phone
If different from above
Cell phone *
Cell phone
Business address
Business address
Business phone
Business phone
Does your child have any siblings?
D.O.B.
D.O.B.
D.O.B.
D.O.B.
D.O.B.
D.O.B.
Pediatrician
Pediatrician
Pediatrician address
Pediatrician address
Pediatrician phone
Pediatrician phone
Contact person
Contact person
Director may contact the above for an assessment of your child in a group setting.
Phone
Phone
Emergency contact *
Emergency contact
Please list 3 people other than yourself
Phone *
Phone
Emergency contact *
Emergency contact
Phone *
Phone
Emergency contact *
Emergency contact
Phone *
Phone
Prices are based on monthly payments
I agree to pay monthly tuition *
All payments and deposits are final *
By accepting I understand that deposits and fees are NON-REFUNDABLE or NON-TRANSFERABLE