MORNING STAR PRESCHOOL
ENROLLMENT FORM
Child’s Name: _____________________
Age by Aug. 1: _______
Mother’s Name: ____________________
Address: _________________________
Home Phone: _____________________
Cell Phone: _______________________
Church Affiliation: __________________
Employer: ________________________
Employer Phone: ___________________
Person to call in case of emergency/illness:
Name: _____________________
Phone: _____________________
Brothers and Sisters:
Name: __________________ Age: _____
Name: __________________ Age: _____
Name: __________________ Age: _____
Father’s Name: _____________________
Address (if different): ________________
Home Phone (if different): ____________
Cell Phone: _______________________
Church Affiliation: __________________
Employer: ________________________
Employer Phone: ___________________
Persons authorized to pick up child other than parent:
#1 Name: _____________________
Phone: _____________________
#2 Name: _____________________
Phone: _____________________
List any information that will help us to know and work with your child. _____________
________________________________
________________________________
Are your child’s immunizations up to date?
Yes: _____No: _____
Does your child have any allergies that we need to be aware of? _________________
________________________________.
Parent Signature: ___________________
Date: ____________
Please complete and mail with $50 non-refundable deposit to:
Morning Star Preschool
202 Main St.
Hope, IN. 47246