Family Information and Income
I certify that, to the best of my knowledge, the information provided in the application is true and accurate. I understand that if any of this information changes or is found to be incorrect, I am obligated to notify Bedford County School immediately. I understand that falsifying information such as family income, number of children, number in my household, or relationship may result in rejection of this application.
I also understand that completing an application does not guarantee my child a place in the preschool program and that notification of acceptance will begin in May and will continue throughout the summer months. Failure to provide all reguired documentation including: birth certificate, proof of residency, proof of income, and updated physical and immunizations, may jeapordize preschool acceptance.
Lyn-CAG and Bedford County Public Schools do not discriminate on the basis of race, color, national origin, sex, disability, or age in programs and activities.
Parent/Guardian's Name (print) ______________________________________________________________
Parent/Guardian's Signature _________________________________________________________________
Office Use Only:
I _________ H________ P________ D_________
Staff interview ____________ Date ___________