NLC Early Learning Center (Preschool) PRE-Registration

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* 1. Preschooler's First and Last Name

Preschooler's LAST Name

Preschooler's FIRST Name

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* 2. My preschooler will be 4 years old by August 31, 2022.

Yes

No

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* 3. Preschooler's Date of Birth

Month

Day

Year

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* 4. Parent's Names

Parent's LAST Name(s)

Parent's FIRST Name(s)

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* 5. Family Mailing Address

Street or P.O. Box

City

State

Zip Code

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* 6. Family Telephone Number

1.

2.

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* 7. Parent Email Address

1.

2.