Thank you for taking the time to pre-register your child.

Don't forget to schedule your intake appointment, please call 704-630-9085.

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* 1. Child's First Name

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* 2. Child's Last Name

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* 3. Is your child a twin?

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* 4. What is the gender of your child?

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* 5. What is your child's date of birth?

Date

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* 6. Parent/Guardian Full Name (1st point of contact)

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* 7. Parent/Guardian Full Name (2nd point of contact)

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* 8. Please provide your mailing and contact information.

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* 9. Alternate phone number if applicable.

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* 10. Alternate email address (if applicable):

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* 11. Has your child been diagnosed with any developmental or health concerns?

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* 12. Does your child have limited English proficiency?

*IMPORTANT - Please note that some sites on our list may not become a NC Pre-K site due to lack of funding resources or other eligibility criteria not being met. If you selected a site that did not receive funding, we will attempt to place your child at one of your other options. Ultimately, Smart Start Rowan reserves the right to make child placement decisions. Families may opt to be placed on a waiting list if their child was placed at a site they do not prefer.
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