Preschool-Aged Child Census Form printable pdf download

Preschool-Aged Child Census Form

Bradt Primary School

2719 Hamburg Street

Schenectady, NY 12303

Preschool-Aged Child Census Form

Please fill out ONE form PER household address. Only list multiple children who live in the

SAME household on this form.

Parent/Guardian:

❒

Mr.

Mrs.

Ms. ____________________________________________________

Last Name

First Name

❒

Mr.

Mrs.

Ms. ____________________________________________________

Last Name

First Name

Address: _______________________________________________________________

Street

Zip

Phone Number: _______________________________________

Child’s Name: _________________________________________ Birthdate: ______________

Last Name

First Name

mo/day/yr

❒

Child’s Address:

same as above

Gender: M/F (Circle)

Child’s Name: _________________________________________ Birthdate: ______________

Last Name

First Name

mo/day/yr

❒

Child’s Address:

same as above

Gender: M/F (Circle)

Child’s Name: _________________________________________ Birthdate: ______________

Last Name

First Name

mo/day/yr

❒

Child’s Address:

same as above

Gender: M/F (Circle)

Please submit this form to Bradt School at the address above.

Thank you for helping us find our next generation of students!

Preschool-Aged Child Census Form

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