Pre-K — Irvington Extended Day Program

Pre-Kindergarten Form

Fields marked with an * are required

Custodial Parent's Name *

Relationship to Child *

Child First Name *

Child Last Name *

Date Of Birth (Day, Month, Year) *

Street Address *

Street Address Line 2

City *

State / Province *

Postal / Zip Code *

Home Phone *

Today's Date *

Age as of August 25th, 2022 *

Expected Date of Entry (Month, Day, Year) *

E-mail *

What school will your child attend for Kindergarten? *

Please inform us of any changes in the information on this form.
Please note that this form is kept for one year and then discarded.

Financial information