Preschool Information

 

2020/2021 Enrollment Form

 

 

Child Information:

 

Name of Child:                                    Child like to be called:                              

 

Sex:  M   F        Date of Birth:                                  

 

Class of Enrollment:   ___ Gentle Giraffes (3 yr olds)    ___ Loving Lions (4 yr olds)

 

Address:                                                            City:                                  

 

Zip Code:                         Home Phone:                                    

 

Email:                                                                       

 

Parent/Guardian & Family Information: 

 

Mother’s Name:  _____________________     Employer: __________________________

 

Work Phone:  ________________________    Cell Phone:  ________________________

 

Father’s Name:  ______________________    Employer:  _________________________

 

Work Phone:  ________________________    Cell Phone:  ________________________

 

If parents are seperated/divorced, please provide custody arrangement:  

______________________________________________________________________________

 

Please provide us with the names of anyone who may be picking up your child:

 

______________________________________________________________________________

 

______________________________________________________________________________

 

Emergency Release Information:

 

Emergency Contacts:  ___________________________ Phone Number:  ______________

 

Name of Physician:  _____________________________  Phone Number:  ______________

 

Allergies:  _________________________________________________________

 

Medical conditions:  _______________________________________________

 

  • I have completed this form.  I understand that St. Paul’s Community Preschool reserves the right to dismiss or suspend any student whose presence in the school is considered detrimental either to the student’s or the school’s best interest.
  • I understand my child will be photographed and that these will be published.

 

Signature:  ______________________________    Date:  _______________________

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