2018-2019 Preschool Registration Form

Child's Name

Nickname

Birthdate

Age

Home Address

Mailing Address (if different)

Preferred Email

This address will receive a confirmation email

Preferred Phone

Known Allergies

Special Needs

Has your child had any previous group or preschool experience? If so, when and where?

Does your child attend a church? If so, which one?

Child lives with

Father Mother Grandparents Siblings Other

How did you hear about Little Hands Las Manitas Bilingual Preschool?

Family Information

Father's/Guardian's Name

Father's Cell

Occupation

Work Phone

Mother's/Guardian's Name

Occupation

Work Phone

Name and age of siblings

Program Registration

In case my child is hurt or becomes seriously ill, and I cannot be reached, I give permission for my child to be given emergency treatment.

Electronic signature - please type first and last name of parent/guardian

Please select the class option you are registering your child for

2-day class option - Tues./Thurs. - 8am-11am $200/mo. Sept.-May 3-day class option - Tues./Thurs./Fri. - 8am-11am $280/mo. Sept.-May

Registration Fee

Please submit a $50 non-refundable registration fee to Las Manitas Bilingual Preschool * 591 Gatch St. * Woodburn, OR 97071. Registration is not complete until fee is received. 0

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

September 2018 - May 2019

Please fill out this form and click submit.

2018-2019 Preschool Registration Form

Description

Please Fix the Following