2026-2027 Preschool Registration Form 4 Year Olds

(Child must have turned 4 on or before September 1 to be eligible for enrollment)
*All classes are subject to change due to enrollment numbers.

Honeypot

Student's full name:

Person registering this child:

Name you want used in school on name tags, cubby, ect:

Birth date:

Date

Age:

Gender:

Immunizations up-to-date?

Early childhood screened?

Has received early intervention services or early childhood special education in the past?

If yes, was re-screening recommended?

English spoken fluently?

If no, which language?

Primary caregiver(s)? (check all that apply)

Father's name:

Father's Address:

Father's City/State/Zip:

Father's Primary Phone/Cell #:

Format: (000) 000-0000.

Father's Place of Employment:

Father's Email:

Mother's Name

Mother's Address:

Mother's City/State/Zip:

Mother's Primary Phone/Cell #:

Format: (000) 000-0000.

Mother's Place of Employment:

Mother's Email:

Please indicate your 1st, 2nd, 3rd & 4th choice for class options: (additional classes may be offered based on enrollment)

Rows	Rate 1st-4th Choice
5 days/week AM 8:00-10:30AM $240 per month
5 days/week PM 12:35-3:05PM $240 per month
4 days/week AM 8:00-10:30AM $200 per month
4 days/week PM 12:35-3:05 PM $200 per month
3 days/week AM 8:00-10:30AM $160 per month
3 days/week PM 12:35-3:05PM $160 per month

Please indicate your 1st, 2nd, 3rd & 4th choice for class options: (additional classes may be offered based on enrollment)

Tuition payments are due on the first class day each month, September-May

$35.00 per child NON-Refundable REGISTRATION FEE due at this time (make checks payable to ISD #813)

I would like to apply for an educational scholarship for my child. Scholarships are income-based. An "Application for Educational Benefits" along with supporting documents must be completed and submitted with this registration form. In addition I authorize Lake City Schools to share my information with Head Start if there is a possibility of income eligibilty. Scholarships will not be awarded until after July 1, 2026.

4 Year Old Preschool Registration Form