Preschool Preregistration
Complete this form and submit the registration fee in order to be added to my list. I will send out the registration packet once I have you assigned to a class!
Child's Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Age on Sept 1
Please Select
3
4
5
Parent Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Preferred Class
T/Th 9:00-11:30
T/Th 12:30-3:00
Either class will work
Would you like to add on the Wednesday Enrichment class for 4-year-olds?
Yes
No
Maybe, I'd like more information
Registration Fee ($60) will be paid via:
PayPal (pianoclam@hotmail.com)
Venmo (@Coralee-Strasser)
Cash
Check
Other
Questions/Comments
Submit
Should be Empty: