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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 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*

Preschool Registration

Name	Age