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Preschool Registration

- Preschool
  - Preschool Information
  - Preschool Registration
    
    Permission to Treat / Health Appraisal Form

Welcome to Preschool Registration!

We are excited to have your child experience our Preschool program! We offer different scheduling options of either 2, 3, 4, or 5 days per week to accommodate you and your child's need.

To register, complete this form below and the Permission to Treat / Health Appraisal Form
Parent / Preschooler Information
The maximum number of form submissions has been reached. This form is currently not available.
- Preschooler Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Program REQUIRED Please fill out this field.
- This is if you are enrolling more than one preschooler, otherwise leave blank.
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Program
- Father / Male Guardian
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- St. Mary's Church Parishoner: REQUIRED Yes No Please fill out this field.
- Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Carrier REQUIRED Please fill out this field. Please enter valid data.
- Place of Employment REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Family Email REQUIRED Please fill out this field. Please enter an email address.
- Mother / Legal Guardian
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- St. Mary's Church Parishoner: REQUIRED Yes No Please fill out this field.
- Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Cell Phone Carrier REQUIRED Please fill out this field. Please enter valid data.
- Place of Employment REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Family Email REQUIRED Please fill out this field. Please enter an email address.
- Student lives with: Mother & Father Mother & Stepfather Father & Stepmother Mother Father Guardians
- $100 per family100.0
Total:

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St. Mary's Preschool

211 4th Street • Aurora, IN 47001
(812) 926-1558

Preschool Registration

Welcome to Preschool Registration!

Parent / Preschooler Information

Preschooler Information

Father / Male Guardian

Mother / Legal Guardian