2025-2026 Preschool Registration

Child Name*

First NameLast Name

Birthdate*

MonthDayYear

Child's Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Home/Work Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Parent Guardian Cell Phone:*

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to the child*

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Home/Work Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to the child

Parent/Guardian Martial Status*

Custodial/ Visitation Arrangements:

Emergency Contact*

First NameLast Name

Relationship to child:

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Who lives in the household?*

Names and ages of other children in the family and school’s attending? *

What languages are spoken in the home?*

Describe any previous preschool/daycare experiences. *

What are your child's interests?*

In order for our teachers to best meet your child’s education needs, please describe how your child best learns?*

Does your child have any difficulty seeing, hearing, walking or communicating? *

Parent/Guardians’ evaluation of child’s health: *

Does your child have allergies or dietary needs?*

Does your child take prescription medication?*

Are there any other health concerns we should be aware of? *

Pediatrician*

Dentist*

Please share any additional information that you think might be helpful to our preschool staff.

If your child is accepted, additional paperwork and deposit must be submitted to KiDiMu within 15 days. Please initial. *

2025 - 2026 Preschool Application