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2018-2019 Preschool Registration Form
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Indicates required field
Student Name
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First
Last
Birth Day
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Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
Chinese Name
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Please type the child's Chinese name, if he or she has one. If not, simply type, "None."
Gender
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Male
Female
Insurance Infomation (Provider & Policy Number)
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Allergy / Medical Infomation
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Please explain any relevant allergies or medical considerations. If there are none, please type, "None."
Father's Name
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First
Last
Email
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Phone Number
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Mother's
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First
Last
Email
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Phone Number
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Desired Start Date (For Late Starters)
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Days / Week
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Choose One
2 Days / Week ($225)
3 Days / Week ($325)
5 Days/Week ($525)
one month's notice agreement
I acknowledge that a one month's notice is required to withdraw from the program or non-attendance. If a one month's notice for early withdrawal is not given, your deposit will not be refunded in any forms unless the deposit will be used towards your child’s account balance as credits. There is no reduction in fee for non-attendance without an one month's notice.
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I agree
Question or Comment
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