Registration Forms

Register Today

Registration for the new preschool term 2023 - 2024, begins on February 1, 2023 and continues until all spots are filled. Registrations are taken on a first come first serve basis and spots are not reserved until a registration form and the $50.00 nonrefundable registration fee for new students and $40.00 registration fee for returning students are returned to the preschool.

There is a print application to download above, or you can fill out the electronic version below. With either option, the registration fee must be dropped off at the preschool in order to complete your child's registration for class.

Name(Required)

Untitled

Date of Birth(Required)

Gender(Required)

Boy

Girl

Prefer to not specify

Please Select Which Class For Your Child(Required)

Please select which class you're interested in for your child. Note that children registering for Primary class must be age 3 by September 1.

Parent Information

All records at Jack and Jill are confidential. No information is given out or shared with any other persons or agencies. Note: If parents share custody, Jack and Jill must be supplied with copies of all legally binding agreements, court directives, and any other executed documents that are applicable.

Primary Custody(Required)

Primarily with Father

Primarily with Mother

With Both Parents

Father's Full Name (First, Middle, Last)

Street Address

City, State, ZIP

Phone Numbers

Include home and cell

Employer

Work Telephone

Can you be contacted at your work number?

Yes

Email Address

Mother's Full Name (First, Middle, Last)

Street Address

City, State, ZIP

Employer

Phone Numbers

Include home and cell

Work Telephone

Can you be contacted at your work number?

Yes

Email Address

Emergency Contact

This is the person who will be called if we cannot reach the parent. This person must be authorized to pick up your child if called by the preschool

Full Name(Required)

Relationship to Child(Required)

Phone Number(Required)

Can include two, if needed

Where does your child go after preschool?(Required)

e.g.: home, to a grandparent, babysitter)

Name and Contact Phone Number(Required)

For person who cares for your child after preschool.

List any services your child is currently receiving.

e.g.: speech therapy, I. U. services)

Home Life

List all members of the household, their relationship to the child, and their ages: (may input two names per field, if needed)

Name and relationship to child

Pick up and drop off

List the people to whom you are giving permission to drop off or pick up your child on a regular basis. (e.g.: grandparents, aunts/uncles, babysitters, neighbors, other persons.) Please note: These are they only people who will be allowed to pick up your child at school unless specific permission is given. If you are involved in a custody situation, the preschool needs copies of all custody papers, P.F.A.’s, or any other documents that outline persons who are to be permitted or excluded from transporting this child.

Name and relationship to child(Required)

Phone Number(Required)

Name and relationship to child(Required)

Phone Number(Required)

Name and relationship to child

Phone Number

Name and relationship to child

Phone Number

Name and relationship to child

Phone Number

Family nicknames

By what name does your child know important people in their life? For example grandmothers could be nana, oma, nanny, granny, grandma, etc. Grandfathers could be called pap, pop, opa, pappy, etc. Many children have specific names for all their grandparents & we do not realize who they are speaking about when they use these terms. Likewise, aunts, uncles, neighbors, special friends of parents may have nicknames that the children use that we might need to know.

Name and relationship to child

Nickname

Name and relationship to child

Nickname

Name and relationship to child

Nickname

Name and relationship to child

Nickname

Pets & Experiences

Names of pets & types of animals, if any:

List any group experiences that your child has had (babysitter, playgroup, Sunday school, daycare, dance, soccer, etc.).

Please note whether or not a parent has been with the child during these experiences

School District where this child will enroll for Kindergarten:(Required)

Church membership, if applicable:

Please note that church membership is not a requirement for your child to enroll at Jack & Jill Preschool.

Heath background

General health of your child:(Required)

e.g., Frail, Occasional illness, Rarely ill, Good health

List any known allergies to food or beverages(Required)

Please list all food restrictions(Required)

Does this child take any medications regularly? If so, please list(Required)

Does this child have any distinguishing birthmarks or physical characteristics? If so, please list(Required)

Is there any reason your child should not participate in physical activities?(Required)

Yes

If yes, please list the activities to be avoided and the reasons(Required)

Are there any other conditions or situations that the school should be aware of when working with your child?

Family Doctor (Name)

Phone

Address

How did you learn about Jack and Jill Preschool?(Required)

What are your child’s favorite toys, games, or stories?

How would you describe your child’s personality?

Additional comments or remarks

Signature of parent registering child(Required)

Please type your name as signature.