Classes:
M-W-F a.m._____
M-W-F p.m._____
T-TH a.m._____
Child’s Name _____________________________________________________________________________________
(First) (Middle) (Last) (Nickname) (Boy/Girl)
Home Address_(Street)_________________________________________________ (City)______________________
Home Phone # ___________________________ Birth Date ___________________
Mother’s Name __________________________ Living at Home? ____ Cell Phone/Pager________
Place of Employment _____________________________ Phone __________________
Father’s Name ___________________________ Living at Home?____ Cell Phone/Pager________
Place of Employment _____________________________ Phone __________________
Emergency contact other than parent:
(1) _____________________________________________________ Phone ______________________
(Name) (relationship to child)
(2) _____________________________________________________ Phone ______________________
(Name) (relationship to child)
Names and ages of other children in the family ________________________________________________
If St. John's Preschool was recommended to you by another person, please include their name._______________
(Signature)________________________________________ Date _______________________________
$35.00 Registration Fee is required. Paid______ Date______ R______Shirt____
Does your child have any known health conditions that the teacher should know about?
_____________________________________________________________________________________
Please list any medication your child is on _____________________________________________________________________________________
_____________________________________________________________________________________
Please list any allergies your child may have ____________________________________________________
Please list any information that will help us to get to know your child better ( fears, favorite activities, characters, etc) ________________________________________________________________________________________
________________________________________________________________________________________
Has your child attended preschool before? Yes __ No__
If yes, name of the school_____________________________________________________________