Creative Preschool Registration Form
To Parents or Guardians:
Please fill in this form and return to the Preschool along with the $15.00 registration fee.
Child’s Name:___________________________________________________
Class Preference:
Morning Classes: M/W 3 Yr. Olds_____ Tu/Th 4 Yr. Olds_____
Afternoon Classes: M/W Pre-K_____ Tu/Th Pre-K_____ 4 Day Pre-K_____
Previously Attended Preschool: Yes_____No_____ Where:______________
Birthdate_____________________ Sex: Male_____ Female_____
Home Address:__________________________________________________
_______________________________________________________________
Home Phone___________________ Cell Phone(s)____________________
Parents: Married_____ Divorced_____ Other_____
Deceased: Mother_____ Father_____
Parents/Guardian with whom child is living:
Name Relationship to child Occupation Phone
_______________________________________________________________
_______________________________________________________________
Other Siblings:
Name Sex Birthdate Live at home?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Special Health Concerns:___________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Allergies:_______________________________________________________
_______________________________________________________________
Interests and Hobbies:_____________________________________________
_______________________________________________________________
Attends Church at:________________________________________________
__________________________
Parent Signature
What I would like my child to gain from this Preschool Experience:_________
_______________________________________________________________
_______________________________________________________________
I will_______will not_________ need transportation to and/or from preschool.