Student Registration Form

Other Information
I give Mt. Vernon preschool permission to photograph my child during school and/or daycare activities.
I acceptI decline
Church Affiliation
Has your child attend any other preschool previously?

YesNo
If yes, where?
Does your child receive any services?

speechearly interventionoccupational therapyother
If other, explain

Medical
Medical Release
I understand that Mt. Vernon Preschool will make every effort to contact me in the event of a medical emergency involving my child. If the school cannot reach me, I give permission for the school to seek medical attention for my child. Any medical fees incurred will be my responsibility. I agree to hold harmless Mt. Vernon Preschool for their actions on my behalf.
I agreeI decline
Child's Doctor
Phone Number

Area Code Phone Number
Is your child allergic to foods, medicine, or insect bites/stings?

noyes
If yes, please list all allergies.
Date

MonthDay Year
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

Learning For His Glory