CWWA Registration Form 2022-2023

Child's Name*

Nickname*

Sex*

Birthdate*

Fecha

Home Address*

City*

State*

Zip*

Parent's/Guardian's Name*

Home Address*

Place of Employment*

Work Phone*

Occupation*

Email Address*

ejemplo@ejemplo.com

Parent's/Guardian's Name*

Home Address*

Place of Employment*

Occupation*

Email Address*

ejemplo@ejemplo.com

Does child live with both parents? Yes [ ] No [

Names and ages of children in family*

Who besides immediate family, resides in the home?*

Language(s) spoken?*

PERSONS AUTHORIZED FOR PICK UP

The following people may pick up my child at Children With Aloha Academy and may be called for emergencies or illness:

Name Address Relationship Telephone

Cell Phone*

Address*

Relationship*

2.Name*

Cell Phone*

Address*

Relationship*

Name*

Cell Phone*

Address*

Relationship*

Name*

Cell Phone*

Address*

Relationship*

Person(s) picking up this child on a regular basis

Name Address Relationship Telephone

Cell Phone*

Address*

Relationship*

2.Name*

Cell Phone*

Address*

Relationship*

3.Name*

Cell Phone*

Address*

Relationship*

4.Name*

Cell Phone*

Address*

Relationship*

Desired date of entry*

Fecha

How did you learn about Children with Aloha Academy Preschool?*

If by personal reference, Name of person who referred you*

Relationship*

General health conditions?*

Does your child have any allergies? Yes ( )No ()Specify:

Specify*

Does your child take naps? Yes ( ) No ( )

How long?*

Methods of home discipline?*

Who disciplines?*

What time does your child go to bed at night?*

What are your child's eating habits and likes/dislikes?*

How often is your child read aloud to?*

What family Activities does your child enjoy?*

Please describe your child's present school. child care environment (other children, activities, relatives).*

Please describe your child's personality characteristics, interests and any special needs.*

Why would Children with Aloha Academy is a good environment for your child?*

What goals do you have for your child while in preschool?*

What are your plans for your child for kindergarten?*

Is your child on a waiting list at another preschool?*