West St Paul Nursery School Registration

Caregiver Information 1
Caregiver 1 Full Name*

First NameLast Name
Caregiver 1 Relationship*

MotherFatherOther
Caregiver 1 Home phone
Caregiver 1 Cellphone*
Caregiver 1 E-mail*
Caregiver 1 Place of Employment*
Caregiver 1 Occupation*
Caregiver 1 Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver 1 Work Phone Number*
Address - Same As Child*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Caregiver 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Caregiver Information 2
Caregiver 2 Full Name*

First NameLast Name
Caregiver 2 Relationship*

MotherFatherOther
Caregiver 2 Home phone
Caregiver 2 Cellphone*
Caregiver 2 E-mail*
Caregiver 2 Place of Employment*
Caregiver 2 Occupation*
Caregiver 2 Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver 2 Work Phone Number*
Address - Same As Childs*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Caregiver 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact - Other than Parent/Guardian
Emergency contact Full Name*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency contact Home phone*
Emergency contact Cellphone
Emergency contact Work phone
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Should be Empty:

West St Paul Nursery School Registration Form