Preschool Registration

Preschool Registration

Name:*
Name to be Called at School:
Birthdate:*
Age as of Sept. 1:*
Sex:*
Address:*
Home Phone:*
-
E-mail:*
Father's Name:
Occupation:
Cell Phone:
-
Work Phone:
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Mother's Name:
Mom's Occupation:
Mom's Cell Phone:
-
Mom's Work Phone:
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Any Siblings attending Resurrection Preschool?
If yes, name and year:
Religious preference:
Place of Worship:
Primary Language Spoken at Home:

I WOULD LIKE TO ENROLL MY CHILD IN:

THREE YEAR OLD PROGRAM (M/W/F):
FOUR YEAR OLD VPK PROGRAM:

EMERGENCY PROCEDURE INFORMATION

Health Problems/Allergies:
Pediatrician
Pediatrician Phone:
-
Hospital Preference:

EMERGENCY CONTACTS

Contact 1*
Relationship:
Contact 1 Phone:*
-
Contact 2*
Relationship (2)::
Contact 2 Phone:*
-
Contact 3
Relationship (3):
Contact 3 Phone:
-

In case of accident or illness where treatment is not needed, but where my child is unable to stay in school, I request the school contact me first. If I am unable to be reached, I request that one of the persons listed on the front of this card to be contacted to care for my child until I can be reached. In the event of a serious accident or illness, I request the school to first attempt to contact me at the phone numbers listed on this card. If the school is unable to reach me, I hereby authorize the school to contact the physician listed on this card and follow his instructions. If it is impossible to contact the physician, the school may make whatever arrangements are necessary to provide emergency care and treatment for my child.I have read and understand the above statement. I hereby give my consent for my child to receive emergency care as described and agree to abide by the school policy.

I have read and understand the above statement. I hereby give my consent for my child to receive emergency care as described and agree to abide by the school policy.

Required*

Preschool DCF Form
Please download, fill out and either attach it to an email or bring it to the preschool.

DCF Know Your Child Care Facility

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