Pre-K Child Care Registration

PRE-K CHILD CARE - AGES 3-5

REGISTRATION FORM
PLEASE READ CAREFULLY AS THERE ARE NEW REQUIREMENTS

After completing the registration form, you will be contacted to fill out additional forms for a complete registration. There is a $35 registration fee that must be paid before child is fully registered.

Please return by email or deliver to the front office before school begins.

Spaces are limited!
Child's Information
Name

First NameLast Name
Age
Upload Birth Certificate

Browse Files

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Upload Shot Records

Browse Files

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Name

First NameLast Name
Age
Upload Birth Certificate

Browse Files

Cancelof
Upload Shot Records

Browse Files

Cancelof
Name

First NameLast Name
Age
Upload Birth Certificate

Browse Files

Cancelof
Upload Shot Records

Browse Files

Cancelof
Parent's Information
Primary (Family) Email
example@example.com
Mother's Name

First NameLast Name
Mother's Phone Number

Area CodePhone Number
Father's Name

First NameLast Name
Father's Phone Number

Area CodePhone Number
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please Note: We are pleased to provide child care during the times specified on the program schedule for children ages 3 through 5 years.

Due to space limitations and regulations, we are able to accept only those children who are registered and fees are paid.

First come first serve. CCDF is accepted. Please have your voucher with you.

In addition, because our space is limited and because of requirements regarding the number of childcare providers, we must require pre-registration for child care through this form. We cannot guarantee childcare for your child unless you return this form. Additional forms will be emailed/mailed to you and must be completed and emailed back to us. Thank you for your cooperation and understanding. This method helps us provide a quality program for your children.

Please email form OR questions to polkids317@gmail.com
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