Preschool Registration Form Page 2

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This box is for office use only.
2016 – 2017
REGISTRATION
Preschool
31655 Downes Rd, Abbotsford, BC
V4X 2M8
Phone: 604-859-3700
Fax: 604-859-7599
Website:
Child’s Name
: ____________________________________________________________________________________
Surname
First Name
Middle Name
Name to be used on preschool name tags, if different from above: _______________________________
Example: Jonathan to Jon; Nicole to Nicki
Hair Color: _______________
Eye Color: __________________
Male
Female
Birth Date
Place of Birth
: ________________
___________________________________
Day
Month
Year
Country
Province (if Canada)
Mailing Address
: _________________________________________________________________________________
Street
_______________________________________________________________
(______) ________________________
City
Province
Postal Code
Home Phone
Parent E-mail
Language spoken at home
: _________________________________________
: ______________
Mother
Father
: __________________________________
: _____________________________________________
Surname
First Name
Surname
First Name
Mother’s Cell Phone #
Father’s Cell Phone #
: (_____) __________________
: (_____) ____________________
Mother’s Place of Employment
Work Phone
____________________________
: (_____) ____________________
Father’s Place of Employment
Work Phone
_____________________________
: (_____) ____________________
Legal Guardian
Work Phone
: __________________________________________
: (_____) ____________________
(If applicable)
Student resides with:
Father & Mother
Father*
Mother*
Legal Guardian*
Joint Custody*
(at same residence)
No
Yes
*Is a court order in place concerning the care or custody of the student
If yes, please attach a copy. In
absence of information, both parents will have access to the student and student’s records.
Brothers and Sisters (Names, Boy or Girl, Birthdates; please indicate if any are enrolled at MEI):
Name
Boy/Girl
Birth date
At MEI
Name
Boy/Girl
Birth date
At MEI
Three Persons Authorized to Pick Up Your Child from Preschool
These persons must also be willing to be contacted if the parents / guardians are unable to be contacted in the
event of an emergency or unexpected illness.
Name
Relationship to Child
Home Phone
Work / Cell Phone
Church Affiliation
If this is an MEI Society church, please indicate whether
: ______________________________
one of the following is a member of the church:
Parent
Legal Guardian
None
Brothers and Sisters previously enrolled in MEI Preschool:
__________________________________________________________________________________________

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