Child’s Name ________________________________________________________________
Parent’s Names ______________________________________________________________
Address ___________________________________________________________________
Town __________________________ State ____________________ Zip _______________
Home Phone __________________________ Cell Phone ______________________________
Email____________________________________
Date of Birth __________________ Sex

Male

Female
Please indicate your First and Second choice for your child’s preschool experience. Place a 1 on the line of your first choice school and a 2 on the line of your second choice. You have the option of choosing the waitlist of your first choice school for your second choice.
Registration fee of $15.00 is due upon enrollment in the program.
In our ongoing effort to meet the needs of our students, we are currently looking into enrollment and configuration of our integrated Pre K programs in Berlin and Boylston. Therefore final enrollment will be determined in the coming weeks.
Indicate Preference for the Integrated Preschool Programs

AM

PM
___ Berlin Integrated Preschool 3 & 4 year old program (AM or PM)
___ Boylston Integrated Preschool 3 & 4 year old program (AM only)
___ Tahanto Regional Preschool 3 year old program (T/TH 9:00 AM – 11:30 AM)
___ Tahanto Regional Preschool 4 year old program (M/W/F 8:30 AM – 11:00 AM)
___ Waitlist for my first choice preschool program
Berlin-Boylston Public Schools do not discriminate on the basis of race, sex, religion, disability, national origin, sexual orientation, or homelessness.