ABC PRESCHOOL  REGISTRATION FORM

Date of application:

 

Child Information

Name of Child (male or female):

 Birth Date:

Parent Information

Mother  Name:

Home Address:

Home Phone:

Work Place and phone:

Father  Name:

Home Address:

Home Phone:             

Work Place and phone:

FAMILY EMAIL ADDRESS:

Caregiver Information

Name:

Phone:

                       

Persons authorized to pick up  your child:

 

 I am registering my child for :

 

            3 year old class :

                                         Tuesday & Thursdays  9-11 _____

 

                                         Wednesday 9-11_____                 

                                     

            4 year old class:

                                        Tuesday & Thursday 12-2:30______

 

My child  needs to come to school at the same time as : 

 

Allergies school needs to know about (food, bee sting...) or special needs :