Preschool/daycare Student Registration Form

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Revised May 2016
Sacred Heart Preschool/Daycare
Student Registration Form
Name: ___________________________ Birthdate: ________________________________
(mm/dd/year)
Start Date: ________________________ Gender: M _____
F _____
Address: ___________________________________________________________________
Is your child of Aboriginal ancestry? ______
If yes, do you live on reserve? ________
Mother’s Name: _______________________
Home Phone # __________________
Cell #: __________________________
Mother’s place of work: __________________
Work Phone: _____________________
Father’s Name: ________________________
Home Phone # __________________
Cell #: __________________________
Father’s place of work: __________________
Work Phone: _____________________
Has your child had previous experience away from home?
YES
NO
If yes, please explain:__________________________________________________________
Do you think your child is comfortable leaving parent?________________________________
Siblings names & birthdates: ____________________________________________________
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