Fall + Spring Registration

Please fill out the following form to submit an application for the Chalkboard Preschool. The fields marked with a “*” are required, while the other fields are optional. This is a secure form.





Fall/SpringSummer

AMPM

MondayTuesdayWednesdayThursdayFriday

Parents(s) or Other Person(s) Placing the Child























2nd Parent or person Placing the Child























Other Person to Notify if Person Placing the Child Cannot Be Reached

















Physician to Call if Child Becomes Ill or Injured











Child Information





















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