Application for School Year

Child's Full Name:(*)

Date of Birth:(*)

Home Address:(*)

Home Phone

Mother's Name:(*)

My Child Calls Me:

Cell Phone:

Email address(*)

Occupation:

Business Address:

Work Phone:(*)

Father's Name:(*)

My Child Calls Me:

Cell Phone:(*)

Email address(*)

Occupation:(*)

Business Address

Work Phone:

Sibling:

Age:

Sibling:

Age:

Parents Marital Status:

Does the child live with both natural parents?

Name:

Phone

Relation to Child:

Pediatrician:

Address:

Phone:

Alergies

For snack my child likes to eat:

For lunch my child likes to eat:

My child loves to:

When child is upset, what calms him/her down?

Language(s) spoken at home:

Language(s) spoken by child:

How does your child respond to new situations:

Any other information you would like us to know about your child:

How did you hear about our Preschool?

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