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Preschool
Registration Form
Today's Date
Session:
Mon/Wed a.m. Pre-3 & 4 class
Mon/Wed p.m. Pre-3 & 4 class
Tues/Thurs a.m. Pre-3 class
Tues/Thurs a.m. Pre-4 class
Child's First Name
Last Name
Gender:
Male
Female
Birth date
Age upon entering school:
Child's Address
City
State
Zip/Postal Code
Father's First Name
Last Name
Father's Address
City
State
Zip/Postal Code
Cell Number
Email Address
Place of employment:
Work Phone Number
Mother's First Name
Last Name
Address (if different than above)
City
State
Zip/Postal Code
Cell Number
Email Address
Place of employment:
Work Phone Number
Is the child living with both parents?
Yes
No
If not, with whom? Relationship
Address
City
State
Zip/Postal Code
Names and ages of siblings:
List of people approved to bring and pick up child:
Names of people NOT approved to pick up your child:
Local Church Affiliation:
Would you like to be contacted regarding information about First Reformed Church
Yes
No
Submit