Registration Form

Free and Reduced Application 15.16.pdf
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REGISTRATION.pdf

Panther Preschool Registration 2017-2018

Central York High School

Preschool Lab Program

(sessions subject to change)

Please check preferred session.

   _________ 3 year olds (T/TH)

  __________ 4 year olds (M/W/F)

Date received __________ (office use)

Child's Name________________________________________________________________________                      
                                 (Last)                           (First)  
                           (Middle)                                      (Nickname)

Child's Birthdate_________________________       Current Age ___________       Gender __________                                                             Month/ Day/ Year

Parent/Guardian Names_______________________________________________________________

Elementary School child will be attending (if known)________________________________________

Address: (Please include street name)

___________________________________________________________________________________

___________________________________________________________________________________

E-mail Address_______________________________________________________________________

Telephone Numbers :

Home  ___________________________  Cell_______________________________________________

Other_______________________________________________________________________________

Other Persons at   Home                       Age             Relationship

______________________________________  __________  _________________________

______________________________________  __________  _______________________ __

______________________________________  __________   _________________________

______________________________________  __________    _________________________

Languages Spoken at Home  ___________________________________________________________

List any health concerns _______________________________________________________________

____________________________________________________________________________________