Register – Cathedral Preschool

Student Information
Students must be of age three, four, or five by August 1st and completely potty trained.
Student Name*
First Middle Last
Preferred Name
The name you wish the student to go by while at school.
Gender*
- Female
- Male
Date of Birth*
Date Format: MM slash DD slash YYYY

Names & Birth Dates of Siblings

First	Last	Date of Birth

Address*
The primary address where the student resides.

Street Address Address Line 2 City State ZIP Code
Previous School Experience
Understanding the previous school experience of the student helps to ensure proper placement in the program.
- Daycare
- Preschool
Other Student Details
Please share any information about the student that you think we need to know.

Classes & Care Days
Please indicate the number of days the student will be attending Preschool Class and WrapAround Care. We will do our best to accommodate.
Special Consideration
We 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 Days
Indicate 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.
WrapAround Care Days
Indicate the number of days per week the student will be attending WrapAround Care.

Primary Parent/Guardian Information
The Primary Parent/Guardian is our first point of contact.
Name*
First Last
Email*
Phone*
Employer
Work Phone

Secondary Parent/Guardian Information
The 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*
Employer
Work Phone

Immunization Certificate
A 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 Preschool
- Upload
- FAX to (270)683-3621
Immunization Certificate*
Accepted file types: pdf, jpg, png.
Primary Care Physician
Provide contact information about the primary care physician of the student.
Name*
First Last Suffix
Phone*
Allergies
Food Allergies
Identify 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 Avoided

Indicate 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
Name
This field is for validation purposes and should be left unchanged.

Student Information