Interest Form
Fill out the form carefully for registration
Parent 1
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your child currently enrolled, previously enrolled, or a newcomer to UCUMC Weekday School?
Currently Enrolled
Previously Enrolled
Newcomer
How many children are you applying for?
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Next
Student Information
Name
First Name
Last Name
Gender
Male
Female
Birthday
-
Month
-
Day
Year
Date
Previous Preschool/Daycare
Allergies:
Developmental Delays:
Speech/OT Services:
Potty Trained?
Yes
No
Working
Class (First Choice)
Class (Second Choice)
Extended Day?
Yes
No
Back
Next
Student Information
Name
First Name
Last Name
Gender
Male
Female
Birthday
-
Month
-
Day
Year
Date
Previous Preschool/Daycare
Allergies:
Developmental Delays:
Speech/OT Services:
Potty Trained?
Yes
No
Working
Class (First Choice)
Class (Second Choice)
Extended Day?
Yes
No
Submit
Should be Empty: