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* 1. Child's Full Name

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* 2. Child's Date of Birth

Date

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* 3. Desired Location (please rank)

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* 5. Parent/Guardian Name

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* 6. Parent/Guardian email address

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* 7. Parent/Guardian Best Contact Phone Number

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* 8. The following items assist in determining eligibility. Please check all that apply:

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* 9. I understand that my child must be 4 years old by September 1, 2020 and that they must attend 100 hours of instruction (attend every day) in order to be eligible for this free preschool opportunity.

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* 10. Electronic Signature

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