Admissions Form

Please fill out the whole form and submit it, and we will follow up with you soon. Thank you for your interest in Presbyterian Preschool of Santa Rosa.

Child's First Name

Child's Middle Name

Child's Last Name

Child's Sex

Nickname used at home?

Birth date

Home phone

Cell phone

Address 1

Address 2

Zip

Father's Name

Mother's Name

Father's Occupation

Mother's Occupation

How did you hear about us?

Are you members of First Presbyterian Church?

If not, are you a member of another Christian church?
Enter name if yes:

If you have other children, please list their names and ages: