Hodgson Preschool Application Print   |  Hodgson Preschool Home  |  Close Window  
   
       
School Year:    
Session Preferred: AM PM
       
Your (First & Last) Name:    
Email Address:    
       
Child's (First & Last) Name:    
Nickname:    
       
Child's Age:    
  Sex (M/F):   Birthdate:    
       
Telephone Number:    
     
       
Street Address:    
  Development:    
       
City:    
  State:   Zip:    
       
Father's  (First & Last) Name:    
  Work Phone No.:    
       
Place of Employment:    
       
Mother's  (First & Last) Name:    
  Work Phone No.:    
       
Place of Employment:    
       
Emergency Contact:    
  Phone Number:    
(Other than parent)      
       
Child's Doctor:    
  Phone Number:    
       
Names, Ages of Brothers & Sisters:    
       
Previous School Experience:    
       
Physical Disabilities, Food Allergies, Special Information About Your
Child or Comments:		    
       
Upload (Attach)
Relevant Documents
 [ DO NOT ATTACH A BIRTH CERTIFICATE OR DOCUMENTS CONTAINING SOCIAL SECURITY NUMBERS ]		    
       
Today's Date:    
       
Signature Acknowledgement (Please Check):
    I acknowledge that the above information is true and valid. I understand I will need to physically sign this document before my child begins his or her session at Hodgson Preschool.
       
Security Form Verification (please identify image [ right ] by selecting it from the pulldown menu):