Dixie State College Preschool 2008-2009 Registration Form
Instructions: Use tab key or mouse to navigate through form. Do Not Press Enter.
All information on the registration form must be completed to be accepted
Specify, in numerical order, your class time preference.
Select 1 for your first choice.
Select 2 for your second choice.
Select 3 for your third choice.
Select 4 for your fourth choice.
Mon/Wed AM
1
2
3
4
Tue/Thur AM
1
2
3
4
Mon/Wed PM
1
2
3
4
Tue/Thur PM
1
2
3
4
If your first desired class is filled, then your child will be placed in the next desired choice.
Child's full name:
Last
First
Middle Initial
Sex:
Boy
Girl
Birthdate:
Month
Day
Year
Home Telephone:
(
)
-
(123)
123
-
4567
Home Address:
Mailing Address:
E-Mail Address:
Mother's Name:
Occupation:
Employer:
Employer's Address:
Work Telephone(s):
ext.
Father's Name:
Occupation:
Employer:
Employer's Address:
Work Telephone(s):
ext.
IN CASE OF EMERGENCY WHO DO WE CONTACT?
(If neither parent can be reached)
Name:
Relationship
Address:
Telephone Numbers:
When submitting please only click once.
Fill out form later and return to the Dixie State College Preschool Web Page.
