Lancaster & Clarence New York Preschool Center

Preschool Enrollment form

* You will need to submit this form for each of the children you want to register. This will provide us specific information on a per child basis.

CHILD-PARENT INFORMATION
Full Name of Child:
Nickname:
Sex:


Date of Birth:
Immunization Up to Date?:


Please list ANY allergies in detail that you child may have:
Mothers First and Last Name:
Fathers First and Last Name:
Street Address (Childs Residence):
City:
State:
Zipcode:
Home Phone No.
Subdivision Name:
CONTACT INFORMATION
Mother Work Phone: Ext.
Mother Cell Phone :
Mother Email :
Father Work Phone : Ext.
Father Cell Phone :
Father Email:
Emergency Contact Name:
Emergency Contact Home Phone No.
Emergency Contact Work Phone No. Ext.
Emergency Contact Cell Phone No.
AUTHORIZATION

Please review the information you have provided above for accuracy before pressing the "submit" button below.

You must be the PARENT or LEGAL GUARDIAN of the child listed above. Your submission of this information to Jackson Pond Preschool is your authorization to use the information in the best interest of the child and Jackson Pond Preschool.

Upon your submission below, you are requesting that your child be admitted into the Jackson Pond Preschool for the current school year. Your registration will not be complete until the Jackson Pond Preschool office has processed your registration fee. The fee is Non-Refundable.

Non-Discrimination Policy

Jackson Pond Preschool admits students of any race, color, sex, or national or ethnic origin to all the rights, priviledges, programs and activities generally accorded or made available to students at the school. Jackson Pond does not discriminate on the basis of race, color, sex, or national or ethnic orgin in administration of its educational policies, admissions policies, scholarship programs, and other school-administered programs.

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