Pre Kindergarten  Registration  For 2012-2013 School Year

My child is Pre Kindergarten age (4 years old by September 1).

Child’s Name     Date of Birth   

Street address and City 

Phone

(Day) 

(Evening) 

(Cell) 

Babysitter/Preschool 

Father’s Name    

Mother’s Name 

Who does the child live with (i.e. Mother, Father, Both parents) ?