Child enrollment form

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About
Programs
News
Parents

Child enrollment form

Child's Name *

First

Last

Nickname (if any)

Birthdate *

Gender *

Male
Female

Main contact phone number *

Address *

City *

State *

Zip *

Email Address *

Parent 1 Name *

Parent 1 Occupation

Parent 1 Phone *

Parent 2 Name

Parent 2 Occupation

Parent 2 Phone

Has your child previously attended a nursery school or preschool program? *

Yes
No

If so, where/when?

If the school was DNPCCNS, which teacher?

Please list siblings with age and gender

If a sibling will be attending DNPCCNS this year, list them here

School and district child will attend kindergarten

Is English the primary language spoken in your home?

Yes
No

If English is not the primary language, specific the primary language

Does your child speak and understand English?

What ethnic or religious holidays does your family celebrate?

Would you share your traditions in the classroom?

Do you have a special skill to share with the children?

Has your child developed a hand preference?

Yes, Left handed
Yes, Right handed
No

Behavioral description of your child (social, quiet, energetic, independent, etc.) that might be helpful:

Does your child have playmates of the same age?

Describe your child's special interests (toys, games, sports, etc.):

Does your child have any fears that would be helpful for your teacher to be aware of?

Does your child have any special needs? If yes, please explain.

Child's Physician

Physician phone number

Allergies

My child has allergies

List ALL allergies including food sensitivities; describe reaction and treatment

If medication needs to be administered by teacher, please complete Medication Permission Form obtained in the office.

Check box if EpiPen is prescribed

EpiPen is prescribed

Dutch Neck Presbyterian Church
Cooperative Nursery School
"DNPCCNS"
154 South Mill Road
Princeton Junction, NJ 08550

609-799-9490
For General Questions, Email: dnpccns@aol.com

For Website Issues, Email: webmaster.dnpccns@gmail.com