Student Name *

First Name

Last Name

I would like to register my child for *

Twinkles Class (must be 2 by 3/1/25) • M/W 9:30 am - noon • $340/month + $60 Annual Supply Fee

Stars Class (must be 3 by 6/1/25) • M-Th 9:30 am - 1:00 pm • $540/month + $120 Annual Supply Fee

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best number to text for preschool reminders, announcements, snow days, emergencies, etc.

(###)

###

####

Birth Date *

MM

DD

YYYY

Baptism Date

If applicable

MM

DD

YYYY

Parent/Guardian 1 Name *

First Name

Last Name

Parent/Guardian 1 Best Contact Number

(###)

###

####

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 2 Best Contact Number

(###)

###

####

Primary Emergency Contact NOT already listed on this form

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Check if applicable

This is my child's first time away from his/her parent or guardian

This is my child's first time in an English-speaking environment (or has limited experience in an English-speaking environment)

My child

Uses the bathroom independently

Needs reminders to use the bathroom (dresses/undresses and wipes independently)

In the last year, my child has

Check all that apply

Been cared for by a family member or sitter outside of immediate family

Attended traditional preschool or day care

Attended outdoor preschool or day care

Gone to a parent/toddler group

Taken lessons or participated in team sports in person

Had social & play interactions with children who live in a different household

By nature, my child is

check all that apply

Friendly

Assertive

Shy

Sensitive

Active

Independent

At preschool, my child will be

Vegetarian

Vegan

None of the above