Preschool Interest Form
Currently enrolling for 2023-2024
Parent Name(s)
First Name
Last Name
Parent Name(s)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Best reached by:
Text
Call
E-mail
example@example.com
Children Name(s)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Children Name(s)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
School District
Family Size:
Estimated Annual Income:
We're asking for this information to help us determine financial eligibility for tuition assistance
Do you have Title XX?
YES
NO
Need to apply
Need more info
Enrolling for
Fall
Spring
Summer
Would you like a tour? (We will contact you with potential dates and times for your availability.)
YES
NOTE: Children who are 4 years old by September 30th and live within CCSD may be given priority within the program for the 2023-2024 school year.
Gladden Community House
183 Hawkes Avenue
www.gladdenhouse.org
Submit Form
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