Child’s Name:_____________________________________ Sex: _______Date of Birth:_______________

Home Address:________________________________________________________________________________________

Zip Code:_______________________

Home Phone:___________________

Mother’s Name:___________________________________________

Work Phone:__________________
Cell Phone:_____________________

Father’s Name:_____________________________________________

Work Phone:_________________
Cell Phone:___________________

Email Address:_________________________________

Date of Admission: Fall______ Spring_____

Application for:_______ Polliwogs (2 yr. old class) Tuesday/ Thursday, 8:30-12*

________Tadpoles (2 yr. old class) Monday/ Wednesday/ Friday 8:30-12

________Frogs (3-5 yr. old class) Monday-Friday 8:30-12**

________Full Day (2-5 yr. old) Monday-Friday 8:30-3:00

________Full Day + Early Care & After Care (2-5 yr. old) Mon-Fri 8:00-5:00

*Child must be 2 years old by September 1 for Fall
**Child must be 3 years old by September 1 and must be 3 years old by January 1 to enter the Frog Class in the second semester. Toilet trained upon entry into Preschool is preferred.

Presbyterian Preschool is a non-profit organization. The annual registration/supply fee is due in late August and is non-refundable.

A physician’s examination form which includes a lead screening, TB test and Chicken Pox Vaccination must be completed and returned by the first day of School. Further information will be sent to you concerning enrollment and the upcoming school year. Please contact the Presbyterian Preschool Director with any questions you may have

Parent Signature________________________________________________Date_______________________