Online registration available at www. isd622. org / preschool
2017-2018 Registration Form
After completing this registration you will receive enrollment forms. All enrollment paperwork must be completed and submitted by Sept. 1 to ensure your child can start preschool on the first day of class.
Child’ s Name:
For office use only Date Registration Received:
□ Male
□ Female
Birthdate: Home Phone:
Address:
City State Zip
My child has participated in Early Childhood Screening: □ YES □ NO
Parent 1 / Guardian Name: |
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Parent 2 / Guardian Name: |
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Address: |
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Address: |
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Alternate Phone: |
h | w | c |
Alternate Phone: |
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Email Address: |
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Email Address: |
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Please list your preference of preschool class by location, morning / afternoon, and days of week: First Choice:
Location:
Check #:
□ Morning
□ Afternoon Days of Week:
Second Choice:
□ Morning Location: □ Afternoon Days of Week:
Third Choice:
□ Morning Location: □ Afternoon Days of Week:
Are you interested in joining the District 622 Early Childhood Advisory Council? □ Yes □ No
A $ 50 non-refundable registration fee is required with each registration( with the exception of classes at Richardson and Webster Elementary.)
Please charge $ 50 to: □ Visa □ Mastercard □ Discover Card #: Exp. Date: CVV: Signature:
Limited financial assistance available to qualifying families. Check here to have a Financial Assistance Application mailed to the child’ s home address listed above. The form is also available online at www. isd622. org / preschool. Children age five on or before Sept. 1, 2017 are not eligible for assistance.
Early Childhood & Family Programs | Beaver Lake Center | 1060 Sterling St N, Maplewood, MN 55119 651-702-8411