Wellesley Preschool Registration Form

Wellesley Preschool Registration Form

Please complete the form in its entirety. We look forward to meeting you!
Child's Name*

First NameMiddle InitialLast Name
Birth Date*

MonthDayYear
Child's Preferred Name (if applicable)*
Child's Preferred Pronoun (he/she/they)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Special medical or additional information helpful in an emergency: (food restrictions, allergies, anaphylaxis or other know medical conditions and medications)*
Parent/Guardian Name*

First NameLast Name
Preferred Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Alternate Phone Number
Please enter a valid phone number.
Parent/Guardian Preferred Pronoun (he/she/they)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name

First NameLast Name
Preferred Phone Number
Please enter a valid phone number.
Email
example@example.com
Alternate Phone Number
Please enter a valid phone number.
Parent/Guardian Preferred Pronoun (he/she/they)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do both parents/guardians live with the child?*

YesNo
Please indicate custody arrangements (if applicable)

JointSingleSole
Is this a legally binding agreement?

YesNo
Emergency Contact

This emergency contact - other than the parent/guardian - needs to be reachable during preschool hours, live near-by, and must understand the potential need for them to be called upon.
Emergency Contact Name*

First NameLast Name
Preferred Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Relationship to Child*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other adults authorized to pick up my child(please list any and all names of the people who may be sent to pick up your child throughout the school year)*

Board Selection
As members of a cooperative preschool, full participating parents/guardians are required to serve on one of the following board member positions which facilitate its day-to-day operations.

Listed below are all the board member positions. If you selected full participating, please select any positions in which you would be interested in serving. Board positions will be assigned based on interest and enrollment.
Board Positions I would be interested in include:

1. President2. Vice President/Public Relations3. Secretary/Newsletter4. Treasurer5. Membership6. Fundraising & Special Events
Should be Empty:

Wellesley Preschool Registration Form

More Information about Your Child

Health & Medical Information

Board Selection