Preschool with Bilingual Teaching in Chinese and English

Information of Child

First Name:

Last Name:

Nickname:

Gender:

Boy

Girl

Date of Birth:

(mm/dd/yyyy)

Age on September 1:

Primary language spoken at home:

Information of Parent(s) or Guardian(s) with Whom Child Lives

^#1 First Name:	Last Name:
Address:
City/Town:	State:	Zip:
Phone:	Cell Phone:
Email:

^#2 First Name:	Last Name:
Address:
City/Town:	State:	Zip:
Phone:	Cell Phone:
Email:

Additional Information of Child

Has you child had any group experiences with other young children?

Is your child currently participating in a play group or enrolled in an early
childhood program?

When would you like your child to start in the preschool?

Do you have any questions/comments?