Community Preschool Registration Form printable pdf download

Community Preschool Registration Form

Jack

Jill

Community Preschool

Registration Form

Class:

3Yr. Old________

4Yr. Old___________

Child’s Full Name:_____________________________________________________

M____ F_____

Date of Birth:_________________________

Address:____________________________________________________________

Phone:______________________

Email:___________________________

Mother’s Name:______________________

Work Phone:______________ Cell Phone:________________

Employer:___________________________________________________________

Occupation__________________________________________________________

Father’s Name:_______________________________________________________

Work Phone:_______________ Cell Phone:_________________

Employer:___________________________________________________________

Occupation:__________________________________________________________

Does the child live with both parents?___________

Marital Status: M___S___D____

I would like __ not like__ to be included on the class list that is distributed to the families

in my child’s class. This list includes name, address, phone and email.

We hereby understand and agree to follow all rules, regulations and requirements as stated

in the

Jack

Jill

Community Preschool Registration Packet.

Signature: _______________________

______________ Date:_________

Revised 2014 (KObarka/KPax)

Community Preschool Registration Form