Interest Form for Parramore Preschool

Child's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Age
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Mobile Phone*
Email*
Custody*
- Both Parents
- Mother Only
- Father Only
- Legal Guardian Both Parents
Other children (siblings) living at the same address
Name School Grade
Secondary Contact Information
Name Phone
Do you currently receive child care assistance through the School Readiness (SR) program offered by Community Coordinated Care for Children (4C)?
- Yes
- No
This is to certify that all the information on this registration form is true to the best of my knowledge. I understand that inadequate information may result in my child not being placed in Rosen Tangelo Park Preschool. Rosen Tangelo Park Preschool admits students of any race, color, national and ethnic origin, creed, sex, or sexual orientation.*
This is to certify that all the information on this registration form is true to the best of my knowledge. I understand that inadequate information may result in my child not being placed in Rosen Tangelo Park Preschool. Rosen Tangelo Park Preschool admits students of any race, color, national and ethnic origin, creed, sex, or sexual orientation.
- I understand
- I don't understand
CAPTCHA

Name	School	Grade

Name	Phone