Little Saints Preschool Registration Form
43W301 Plank Road I Hampshire, IL 60140 I 847.464.5131
Student Name
First Name
Middle Name
Last Name
Child's Date of Birth
Child's Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name
First Name
Last Name
Mother's Cell Number
Format: (000) 000-0000.
Mother's E-mail
example@example.com
Mother's Employer (if applicable): Name, Address, Phone Number
Father's Name
First Name
Last Name
Father's Cell Number
Format: (000) 000-0000.
Father's E-mail
example@example.com
Father's Employer: Name, Address, Phone Number
Parent's Marital Status
Married
Separated
Divorced
Widowed
Child's Physician: Name, Address, Phone Number, Email
Siblings: Names, Ages
Church Affiliation (if applicable)
What are you expectations of Little Saints Preschool?
What benefits do you expect your child to receive from attending Little Saints Preschool?
Signature
Submit
Submit
Should be Empty: