PRESCHOOL APPLICATION


Date of Application________________

Pupil’s Name ________________________________ Telephone # ____________________

Date of Birth ________________________________

Home Address _______________________________ Zip Code _______________________

 

PROGRAM DESIRED (check one)

Infant Parent Play Group (Infant – 2 years)
   
Toddler Parent Play Group (2-3 years, 2 years by September 1st
   
Pre-School – 3 year old/Junior Group (3 years by September 1st)
AM
PM
Pre-School – 4 year old/Senior Group (4 years by September 1st)
AM
PM

Mother’s Name __________________________ Occupation ________________

Address ________________________________ Telephone # ________________

Father’s Name ___________________________ Occupation ________________

Address ________________________________ Telephone # ________________

All financial arrangements will be made between the director and family, and can be paid monthly.
Arsenal Family and Children’s Center does not discriminate in regards to race, religion, sex,
or national origin.

 

Parent Signature

___________________________________________________________________

 

 

 

Please mail to: Arsenal Family and Children's Center
336 South Aiken Avenue
Pittsburgh , PA 15232

 

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