Preschool Admissions Form Child's Name* First Last Gender*Select OneMaleFemaleBirthday* Month Day Year Address Street Address Address Line 2 City State ZIP / Postal Code Phone Number*Father's InformationFather's Name* First Last Place of Employment* Work PhoneEmail* Cell Phone*Mother's InformationMother's Name* First Last Place of Employment* Work PhoneEmail* Cell Phone*Family InformationPrimary transportation to and from school? (Who can pick up and drop off)* Need preschool pick-up/drop-off?*Select OneYesNoChild lives with:* Other children in the house*Please include names, relationship and agesCountry of Origin*Select OneAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweLanguage spoken in the home* Church affiliation* Religion* Are there any family situations we should be aware of?*Select OneYesNoPlease ListHealth InformationDoes your child have any allergies?*Select OneYesNoPlease ListDoes your child take any prescription medications?*Select OneYesNoPlease ListDoes your child require a special diet or have any dietary restrictions?*Select OneYesNoPlease ListAre there any medical conditions we should be aware of?*Select OneYesNoPlease ListEmergency Contact InformationPlease list two people we can contact in case of emergency where a parent cannot be reached:Name* First Last Relationship* Phone*Name* First Last Relationship* Phone*Family Doctor* Phone*Hospital Preference* Consent to treat*I give my permission for the emergency treatment of my child if requested by Central downtown preschool, the authorized school provider for my child. I agreeBy signing this form, I grant the following permissions:* My child may use play equipment and to participate in all school activities. My child may leave school premises for walk or excursions under staff and approved volunteer supervision. The the teacher or acting teacher may take whatever steps necessary to obtain medical care if needed. My child's photo may to be taken and displayed while at school for promotional purposes. My child may be transported by the school and approved transportation providers. My child may participate in the Christian curriculum provided at Central Downtown Preschool. I agreeSignature*CAPTCHANameThis field is for validation purposes and should be left unchanged.
