Your Name: *


Your Email: *


Subject: *
Info Sheets

Your Child's Class (Pick One) *
T-K 4 Day 4's 3 Day 4's 3 Day 3's M/W 3's T/Th 3's M/W 2's T/Th 2's

Child's Full Name: *


Name child prefers:


Your child's date of birth: *


Child's sex *
Choose: Female Male

Home Address: *


City: *


Zip: *


Home Phone: *


Cell Phone 1 (Mom):


Cell Phone 2 (Dad):


Neighborhood:


Mother's Name (goes by):


Mother's place of employment:


Mother's Work Phone:


Father's Name (goes by):


Father's Place of Employment:


Father's work phone:


Parents are:
Married Widowed Divorced Separated Single

Please list all siblings of your child including age and school attending:


Is your child adopted?
No Yes and child is aware of adoption Yes but child is not aware of adoption

Does your child speak English?
Yes No

Language(s) spoken at home other than English:


Family's Place of Worship:


Describe your child's previous preschool/daycare experience:


Your expectations for this year:


Tell us about your child (special interests, fears etc.):


List special talents, cultural background or things about your occupation that you would be willing to share with the children:


Please list all persons (other than parents) that are authorized to pick up your child (Please include phone number and relation to child):


Please list all persons that are NOT AUTHORIZED to pick up your child :