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Children’s Garden Preschool
5200 Grove Ave., Richmond, VA 23226
Preschool Application Form
Child’s Full Name______________________________________________ Birth Date_________________
Preferred Name___________________________________ Gender:_____F_____M
Address______________________________________________________________
______________________________________________________________
Telephone Number________________ Cell Phone Number_________________ Email_________________
Father’s Name_____________________________ Occupation_____________________________________
Place of Employment_____________________ Cell/Work #_________________ Email_______________
Mother’s Name_____________________________ Occupation____________________________________
Place of Employment_____________________ Cell/Work #_________________ Email______________
Names of Siblings (include ages and if a former student)
_________________________________ ______________________________
_________________________________ ______________________________
Church Family Attends_______________________________________________________________________
Previous Preschool/Group Experiences__________________________________________________________
Special Physical/Emotional/Medical Needs___________________________________
Class Choices in Order of Preference
Mother's Morning Out 12 - 30 months (check any combination of days you prefer):
Monday________ Tuesday _________Wednesday ________ Thursday_________ Friday___________
2 ½ Year Old -2 Day_____ 2 ½ Year Old – 3 Day_____ 2 1/2 Year Old - 5 Day ____
3 Year Old – 4 Day ______ 3 Year Old - 5 Day ________
4/5 Year Old– 5 Day _____
I wish to enroll my child in St. Giles Children’s Garden Preschool. I have enclosed the $75.00 non-refundable registration fee. Please make checks payable to St. Giles Children’s Garden Preschool.
Parent’s Signature___________________________________________ Date________________________
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