Preschool Admission Application

License #197415115

Please use the form below to submit your application.
Should you wish to submit your application via email, fax or in person, you can download an application form, fill it by hand or on your computer and return it to us.

Child's name *

Child's Date of Birth *

Parent (Legal Guardian) *

Home Phone *

Cell *

Address *

Zip *

City and State *

Email *

Parent (Legal Guardian)

Phone number

Cell

Address

Zip

City and State

Are there any issues or special circumstances with your child we should be aware of? *

What are your goals/intentions for a preschool experience for your child? *

How many days would you like your child to attend? (select one) *

5 days (M-F)

3 days (M,W,F)

2 days (T,TH)

Are you interested in after school enrichment classes which would extend your child’s day until 2:00pm?

Yes

If so, how many days per week?

Date of Application *

I certify that I am the parent or legal guardian of this child, and am authorized to make decisions for this child. *

Yes

Name of parent or legal guardian *

By filling this field you are "signing" this application.

Please enter the text you see

Preschool Admission Application

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