Parents name:

Child’s name:

Child’s Date of Birth: (dd/mm/yr)

Day Time Telephone Number:

Home Telephone Number:

E-mail Address:

Date Care is Required:

Program:

Select One Preschool (2 - 4 years) Kindergarten (4 years - 6 years)

How did you hear about
Munchkinz Preschool?

Full Time

Part Time