Application for Enrollment

St. Peter's Episcopal Preschool

925 Mitchell St. Conway, AR 72034

Today's Date ________________

Child's Name ____________________________________________
First - Middle - Last
 
Preferred Name ___________________________________________
 
Date of Birth __________________________ Age_______________
 
Mother's Name ________________Father's Name ________________

Who has legal custody of the child?______________________________

Guardian's Name/s________________________________________

Home Address (street) ______________________________________
 
City - State - Zip _________________________________________
 
Home Phone ______________________________________________
 

Mother's/Guardian's Information
 
Occupation / Employer _____________________________________
 
Work Phone / Cell Phone ______________________________________
Hours _____________________________
 


Father's/Guardian's Information
 
Occupation / Employer _______________________________________
 
Work Phone / Cell Phone_______________________________________
 Hours _______________________________