Registration Form

Preschool Registration
All the areas with this symbol (*) must be filled out.
Student Information
Today's Date*
MM slash DD slash YYYY
Student's Name (First, Middle, & Last)*
First Middle Last
Child's Name/Nickname you want on class list*
Name/Nickname
Gender*
- Male
- Female
Address*
Street Address Address Line 2 City State ZIP Code
Medical Form (Not required until first day of school)
Accepted file types: jpg, png, pdf, , Max. file size: 32 MB.
Date Of Birth*
MM slash DD slash YYYY
Birth Certificate (Not required until first day of school)
Accepted file types: jpg, png, pdf, Max. file size: 32 MB.
Please supply a copy of the child's birth certificate.
Child Attended Presby Preschool for the 2019-20 School year:*

Do You Have A Parent Not Living In Household*
Any Parent that does not live in the same house as the child.
Name*
First Last
Relationship To Student*
Other Relationship*
Custody Arrangements*
Please list legal custody arrangements and any other pertinent information. (You must supply us with a copy of any restraining, custody, visitation, orders and Adoption decree. We will keep this on file.)
Upload*
Restraining, Custody, Visitation, Orders and Adoption decree.
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 32 MB, Max. files: 5.
Church Affiliation*

Do You Have A Caregiver During The Day?*
If both parents are out of the home during the day Then "YES" you have a caregiver
Caregiver's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Caregiver's Phone Number*

Written Answers
Language spoken in home*
What are your child's interests?*
Please note any special food habits, allergies, problems, etc.*
Does your child have any speech, hearing, or other problems of which we should be aware?*
How would you describe your child's personality?*

Preschool Registration

Name	Age