Register Step 1 of 6 - Student Information 0% Student InformationStudents must be of age three, four, or five by August 1st and completely potty trained.Student Name* First Middle Last Preferred NameThe name you wish the student to go by while at school.Gender*FemaleMaleDate of Birth* Date Format: MM slash DD slash YYYY Names & Birth Dates of SiblingsFirstLastDate of Birth Address*The primary address where the student resides. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous School ExperienceUnderstanding the previous school experience of the student helps to ensure proper placement in the program. Daycare Preschool Other Student DetailsPlease share any information about the student that you think we need to know. Classes & Care DaysPlease indicate the number of days the student will be attending Preschool Class and WrapAround Care. We will do our best to accommodate.Special ConsiderationWe do our absolute best to accommodate. Please help us by providing things we should consider when placing the student in the Preschool Class or WrapAround Care. For example, your student may plan to carpool with another student, requiring that both students are in the same class or your student can only attend on specific days.Preschool Class DaysIndicate the number of days per week the student will be attending the Preschool Class. The 2-day (MW or TTh) program is the best option for a 3-year-old that is not attending WrapAround Care.None2 (MW or TTh)3 (MWF)4 (MTWTh)5 (MTWThF)WrapAround Care DaysIndicate the number of days per week the student will be attending WrapAround Care.None2 (MW or TTh)3 (MWF)4 (MTWTh)5 (MTWThF) Primary Parent/Guardian InformationThe Primary Parent/Guardian is our first point of contact.Name* First Last Email* Phone*EmployerWork Phone Secondary Parent/Guardian InformationThe Secondary Parent/Guardian is our point of contact should the Primary Parent/Guardian be unavailable.Name* First Last Email Preference Receive correspondence via email.Email* Phone*EmployerWork Phone Immunization CertificateA copy of a current Kentucky immunization certificate is required for the student to attend preschool or care programs.Submission Preference*Please indicate how you would prefer to submit the immunization certificate.On File with Cathedral PreschoolUploadFAX to (270)683-3621Immunization Certificate*Accepted file types: pdf, jpg, png.Primary Care PhysicianProvide contact information about the primary care physician of the student.Name* First Last Suffix Phone*AllergiesFood AllergiesIdentify all the foods the student should avoid due to allergies. Eggs Peanuts Tree Nuts Milk/Dairy Other Food Allergies Explanation*Provide an explanation of the student's food allergies.Foods to be AvoidedIndicate specific foods that the student should not eat due to dietary restrictions or preference. How did you hear about Cathedral Preschool? Word of Mouth Advertisement Other NameThis field is for validation purposes and should be left unchanged.