Preschool Information

2021/2022 Enrollment Form

Child Information:

Name of Child: Child like to be called:

Sex: M F Date of Birth:

Class of Enrollment: ___ Gentle Giraffes (3 yr olds) ___ Loving Lions (4 yr olds)

Address: City:

Zip Code: Home Phone:

Email:

Parent/Guardian & Family Information:

Mother’s Name: _____________________ Employer: __________________________

Work Phone: ________________________ Cell Phone: ________________________

Father’s Name: ______________________ Employer: _________________________

Work Phone: ________________________ Cell Phone: ________________________

If parents are seperated/divorced, please provide custody arrangement:

______________________________________________________________________________

Please provide us with the names of anyone who may be picking up your child:

______________________________________________________________________________

Emergency Release Information:

Emergency Contacts: ___________________________ Phone Number: ______________

Name of Physician: _____________________________ Phone Number: ______________

Allergies: _________________________________________________________

Medical conditions: _______________________________________________

I have completed this form. I understand that St. Paul’s Community Preschool reserves the right to dismiss or suspend any student whose presence in the school is considered detrimental either to the student’s or the school’s best interest.
I understand my child will be photographed and that these will be published.

Signature: ______________________________ Date: _______________________