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