Preschool Enrollment Form Example

Parent/Guardian Information

  1. Full Name: ___________________________________________
    • Relationship to Child: ______________________________
    • Phone Number: _____________________________________
    • Email Address: ______________________________________
    • Home Address: _____________________________________
  2. Full Name (Optional): _________________________________
    • Relationship to Child: ______________________________
    • Phone Number: _____________________________________
    • Email Address: ______________________________________

Child’s Information

  • Full Name: ____________________________________________
  • Date of Birth: ________________________________________
  • Gender: ☐ Male ☐ Female ☐ Prefer not to say
  • Preferred Start Date: _________________________________

Enrollment Preference

  • Schedule Type:
    ☐ Full-Time
    ☐ Part-Time
  • If part-time, preferred days (check all that apply):
    ☐ Monday ☐ Tuesday ☐ Wednesday ☐ Thursday ☐ Friday

Emergency Contact Information (if parent/guardian cannot be reached)

  • Name: _______________________________________________
  • Relationship to Child: ________________________________
  • Phone Number: _______________________________________

Medical Information

  • Allergies (if any): ______________________________________
  • Medications (if any): ___________________________________
  • Doctor’s Name: _______________________________________
  • Doctor’s Phone Number: _______________________________

Authorized Pickup List

Please list individuals authorized to pick up your child (other than parents/guardians).

  1. Name: _____________________________________________
    • Phone Number: ___________________________________
  2. Name: _____________________________________________
    • Phone Number: ___________________________________

Enrollment Agreement

I understand and agree to the policies and procedures outlined in the preschool’s parent handbook. I also acknowledge that the information provided above is accurate and complete to the best of my knowledge.

Signature of Parent/Guardian: _____________________________
Date: ______________________

For Office Use Only

  • Date Received: _______________________
  • Enrollment Fee Paid: ☐ Yes ☐ No
  • Start Date Assigned: __________________