Preschool Interest Form
Currently enrolling for 2024-2025
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
More Information Through
Phone
E-mail
Child Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Additional Children
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
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 2024-2025 school year.
Gladden Community House
183 Hawkes Avenue
www.gladdenhouse.org
Submit Form
Should be Empty: