APPLIED TECHNOLOGY EDUCATION CAMPUS
PRESCHOOL ENROLLMENT FORM
Date
-
Month
-
Day
Year
Date
Child's Last Name
Child's First Name
Child's Middle Name
Child's Present Age
Child's Birthdate
As of today's date, my child is fully potty trained
Yes
Not yet
Alternate Phone
Father's Name
Mother's Name
Child Lives With/Relationship
Address
Home Phone
Alternate Phone
e mail address
example@example.com
How many people are in the immediate household
Parental Information
Employment Father
KCSD Employee?
yes
no
Employment Mother
KCSD Employee
Yes
No
Family Physician
Phone
Is the child on medication?
If so, which medication & for what?
Allergies/Health Conditions
Preschool enrollment form November 2021
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