Montesano Co-Op Preschool 2021-2022 Application for Enrollment
Registration fee: $40 for one parent/guardian designated as Parent Helper for the first child, $20 for any additional parent/guardian that will be assisting in class. Registration fee can be mailed to the preschool if filling form out online.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Name
First Name
Last Name
Name you would like us to call your child while attending preschool:
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Class for which you are enrolling your child:
(3-4 years of age) 2 Day Tuesday/Thursday 8:30am-11:00am Tuition: $75 per month
(4-5 years of age) 3 Day Monday/Wednesday/Friday 8:30am-11:00am Tuition: $100 per month
Parents/Guardians:
Please note which parent/guardian/family member/friend will be helping in the classroom, and include their birthdate. This information is needed for the required Washington State Patrol background check.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Relationship to Student
Employer/Occupation
Billing party?
Yes
No
Lives with student?
Yes
No
Parent helper?
Yes
No
If yes, birthdate:
Date of birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of second parent/guardian if any:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Relationship to Student
Employer/Occupation
Billing Party
Yes
No
Lives with Student
Yes
No
Parent Helper? If yes, birthdate
Yes
No
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Info
Please list below, in order of contact preference, any adults authorized to pick-up your child. (You must include at least 2 local person to call in the event of an illness, accident, late pick-up or other emergency) A valid photo ID will be required to be shown at the time of pick-up. Montesano Co-Op Preschool will not release any child unless verbal or written permission has been received from a parent guardian. Your child will be released ONLY to the persons indicated below.
Name
First Name
Last Name
Relationship to Student:
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relationship to Student:
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relationship to Student:
Phone Number
-
Area Code
Phone Number
Special physical conditions/allergies to note:
Names and ages of other brothers and sisters in the household:
Names and ages of other people in the home:
Is English a second language in your home? If yes, primary language?
Has your child ever been in preschool before? If yes, where and when?
Are there any custody arrangements we need to be aware of? If yes, what?
Medical Information
Name of child's physician or clinic:
Physician or clinic address:
Name of medical insurance:
Date when child was last examined by physician:
Child immunizations up to date? (We will need a copy of immunization records)
Yes
No
Submit
Should be Empty: