Admission

KIDDIES HEAD START

REGISTRATION SHEET

DATE: ……………...

CHILD’S NAME: ………………………………………………………….

DATE OF BIRTH: …………………………………………………………

AGE: ……………………………………………………………………….

MOTHER’S NAME: ……………………………………………………….

MOTHER’S ADDRESS: …………………………………………………..

WORK TELEPHONE #: …………………………………………………..

HOME TELEPHONE #: …………………………………………………...

CELL # …………………………………………………………………….

FATHER’S NAME: ………………………………………………………..

FATHER’S ADDRESS ……………………………………………………...

WORK TELEPHONE # ……………………………………………………..

HOME TELEPHONE # ……………………………………………………..

CELL # ……………………………………………………………………….

EMAIL: ………………………………………………………………………