Child's Name:

Age at Start of Session:

DOB:

Sex:

Address: 

City:

Home Phone: 

Mother's Name:

Mother's Email:  

Mother's Employer:

Mother's
Work Phone: 

Father's Name:

Father's Email:  

Father's Employer:

Father's
Work Phone: 

Recommended by:

Are You A Parishioner?:

Yes No

Has your child attended preschool/daycare before?:

Yes  No

If Yes, what school?:

Please mark the appropriate session and time preferences below.

Days & Time

Age 3/4's:

Tuesday/Thursday AM
Tuesday/Thursday PM

Older 4's/5's

Monday/Wednesday/Thursday AM
Monday/Wednesday/Thurs  PM

* Note:  Registration is not complete until this form is processed and approved and payments made.
  Additional health questionnaire may be required before child may begin classes.