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Apex Peak Preschool Apex PeaK-8 Language
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K-8 Programs
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Preschool Registration Form
Please note the 4 fields required to submit this form: Name of Child, Age, Gender, and Name of Parent at very end of form. Thanks!
Name of Child
*
First
Last
Age
*
Gender
*
Male
Female
Date of Birth
*
What's your child favorite book or movie?
*
Please tell us three favorite things of your child
*
Primary language spoken at home
*
Place of Child in family
*
Only
First
Middle
Youngest
# of Days to attend
*
2
3
4
5
Planned days to attend
*
Monday
Tuesday
Wednesday
Thursday
Friday
Parent / Guardian 1 Name
*
First
Last
Phone Number
*
-
-
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent / Guardian 2
*
First
Last
Phone Number
*
-
-
Email
*
Address (leave blank if same as above)
*
Line 1
Line 2
City
State
Zip Code
Country
Primary physician / Pediatrician
*
Phone Number
*
-
-
Medical Info. Please check all that apply
*
Vaccinations as recommended by the Surgeon General
Anaphylaxis Allergies
Seasonal Allergies
Gluten /Lactose or any other diet restriction
Diagnosed condition
Seizures or Fainting spells
Registration and Supply Fees are to be paid by check, however we will accept credit cards for tuition payment.
*
Will pay tuition with checks
Will pay tuition by credit card
By entering your name below and submitting this form, you are registering your child to attend Apex Peak Preschool. You will receive by US postal mail a full Registration Package and Parent Handbook. Thank You and welcome to our Peak Preschool Family!
*
Submit
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