BPP Intake form

BEAUMONT/ALAMEDA PRE-K PROGRAM

4043 NE Fremont Street * Portland * OR * 97212 * beaumontprek@gmail.com

Intake form

 

Child’s name__________________________ date of birth__________ gender__________

Address______________________________  zip code_______ home phone ___________

Today’s date___________________              Expected date of entry, _______20 ________

Neighborhood School______________________

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 Custodial parent(s)

Name_____________________________ Relationship to child___________

Work phone number_________________ E-mail address__________________

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I am interested in:

 Full day Pre-K (8:30 AM to 2:45/3:00 PM) _______

There is also a non-refundable registration fee equal to one month’s tuition due with the completed registration form. Do not include payment with this Intake form.

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signature                                         date

Please inform BPP of any changes in the information on this form.

For more information, please visit our website www.alamedaprek.com

 MAILING ADDRESS: ATTN: BPP/IED 1320 NE Brazee * Portland, OR 97212 (503) 287-9751