Application For Preschool Admission Form Page 2
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1
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3Preschool Registration
Current GHA Family? Yes No
Previous GHA Family?Yes No
Student Information
Date:
First, Middle, Last
Preferred Name
Male/Female
Mailing Address
City
State
Zip
Phone Number
Date of Birth
Family E-mail
Applying for what class?
T/TH (3’s)
M/W/F (4’s)
(Child must be completely potty trained by the beginning of the school year to enter 3 or 4 year old programs)
Applying for the school year 20___ to 20___
Parent Information
Preferred Title:
Mr.
Mrs.
Ms.
Dr.
Preferred Title:
Mr.
Mrs.
Ms.
Dr.
Full Name
Full Name
Relation to applicant
Relation to applicant
Mailing Address
Mailing Address
City, State, Zip
City, State, Zip
Home Phone
Home Phone
Occupation
Occupation
Employer
Employer
Work Phone
Work Phone
Cell Phone
Cell Phone
E-mail
E-mail
If parents are separated or divorced, with whom does the child reside? ____________________________
Check if appropriate:
Parents
Parents
Parents
Father
Mother
Father
Mother
Married
Divorced
Separated
Remarried
Remarried
Deceased
Deceased
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Parent category: Life