Preschool Registration

ADMISSION FORM

YEAR 2024-2025
Preschool Admission
Expected Start Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Which class are you wanting to register for?
Student Information
Name

First NameLast Name
Gender
Birth Date

MonthDayYear
School Name
Home Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Hospital Name
Doctors Name

First NameLast Name
Doctors Phone Number
Format: (000) 000-0000.
Parent/Guardian Information 1
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Address - Same As Child
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name

First NameLast Name
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
E-mail
example@example.com
Address - Same As Childs
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Infomation
Is your child immunized?
Upload

Child immunized chart
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Does your child have any allergies?
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications.
Do you authorize us to administer the medications listed above?
Please list the people authorized to pick up your child.
Does your child have any siblings?
If yes, what is their age(s)?
Emergency Contact - Other than Parent/Guardian
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home
Format: (000) 000-0000.
Cell
Format: (000) 000-0000.
Work
Format: (000) 000-0000.
File Upload

CHILD AADHAR
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File Upload

PARENT AADHAR
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Comments
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ADMISSION FORM

Preschool Admission

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian