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Preschool Registration 2017-2018
Child's Full Name(*)

Please let us know your name.

Name the child goes by

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Gender(*)

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Child's Age on September 1, 2017(*)

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Child's Birthdate(*)

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Child's Home Address(*)

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Child's Preferred Phone Number(*)

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Father's Name(*)

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Father's Address(*)

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Father's Employer

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Father's Occupation

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Father's Preferred Phone Number(*)

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Father's Alternate Phone Number

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Father's Email(*)

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Mother's Name(*)

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Mother's Address(*)

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Mother's Employer

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Mother's Occupation

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Mother's Preferred Phone Number(*)

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Mother's Alternate Phone Number

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Mother's Email(*)

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If the child has any brothers or sisters, please provide their: Name, Age, Grade, and if they live with the child being registered for preschool.

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Please list any other persons (not listed above) living with the child, and their relationship to the child.

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Is the child right or left handed?(*)

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Has the child had a previous group or preschool experience?(*)

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If the child has had a previous group or preschool experience, where and when was that?

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Does the child have any allergies or are there any medical problems or concerns of which we should be aware? Is the child on any type of medication?

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Are there any special food or eating instructions?

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Any additional information concerning discipline, child's communication, comforting, etc?

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CLASS PREFERENCE - 3 Year Old Program(*)

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CLASS PREFERENCE - 4 Year Old Program(*)

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If you have had a child previously attend Four Mile Preschool, please tell us his/her name and what year they attended.

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Do you have a home church?

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If you have a home church, would you mind telling us where that is?

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Would you like to be on Four Mile Church's mailing list for activities, services and programs?(*)

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Captcha(*)
Captcha

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