Pre-Kindergarten Registration Program

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

Expected Start Date

Date

Expected Departure Date

Date

Which class are you wanting to register for?

Name

First NameLast Name

Gender

Birth Date

Date

Home Phone

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Health Care #

Doctors Name

First NameLast Name

Doctors Phone Number

Format: (000) 000-0000.

Full Name

First NameLast Name

Home

Format: (000) 000-0000.

Cell

Format: (000) 000-0000.

Work

Format: (000) 000-0000.

E-mail

example@example.com

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Home

Format: (000) 000-0000.

Cell

Format: (000) 000-0000.

Work

Format: (000) 000-0000.

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Would your child like to be in a class with a friend?

If yes, name and age of friend(s)?

Is your child immunized?

Does your child have any allergies?

If yes please list, including any food or drug allergies.

Does your child have any medical conditions?

Does your child require any medication? If yes, please list these medications.

Do you authorize us to administer the medications listed above?

Please list the people authorized to pick up your child.

Does your child have any siblings?

If yes, what is their age(s)?

Comments

If yes, which one?

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home

Format: (000) 000-0000.

Cell

Format: (000) 000-0000.

Work

Format: (000) 000-0000.

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

Pre-Kindergarten Registration Program

Pre-Kindergarten Programs Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian