FDLC On-Line Application

Friendship Developmental Learning Center On-Line Application

Child:

(Print Full Given Name)

Date of Birth: Age:

Parent / Guardian Information:

Home Address: City: State: TX Zip:

Home Phone: Cell Phone: Email:

Does Your Child use a nick name? Nickname, if applicable:

Has your child ever attended preschool before? Did he / she enjoy attending?

Does your child have any known physical disabilities or any type of allergies?

If you answered yes, please describe:

Does your child use the following at home: Crayons? Pencils? Markers? Scissors?

Please list any special interests that your child might have?

Please list any other child and their ages which are still in your home:

Please list any other adult having authority to pick-up your child from FDLC?

Relationship:

Your child will be picked-up at:

Please list Emergency Contact Person and Contact Information:

Additional Comments:

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