Preschool Registration

Our Mission: Provide Care. Nurture Faith. Share Hope.

"*" indicates required fields

Applying for*

PRE-K (4, 5 year olds; Mon,Wed,Fri AM)

PRE-K PLUS (4, 5 year olds; Mon,Tues,Wed,Fri AM)

PRESCHOOL (3 year olds; Tue and Thu AM)

Child’s Name:*

Child’s Birthday:*

Parents’ Names:*

Contact Email Address*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Numbers:

Home:*

Mother’s Work:*

Cell:*

Father’s Work:*

Cell:*

Siblings (Names and Date of Birth):*

Other additional people living in your home:*

Church Membership:*

List any previous school experiences that your child has had.*

Describe the nature of any emotional or social problems that the school’s staff should be aware of.*

Does your child have any allergies that we should be aware of?*

How does your child express anger?*

Does your child eat breakfast? If so, what does your child usually eat?*

Occupation of Father:*

Occupation of Mother:*

Would you be willing to share information on your occupation to the class?*

Yes

List the people that are able to bring your child and pick your child up from school:*

Electronic Signature*

The Preschool admits, for full participation, students of any race, color, religion, or national or ethnic origin, and does not discriminate on the basis of any of these factors in administration of it policies.

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