BREWSTER CO-OP NURSERY SCHOOL
Brewster Presbyterian Church
* * * * * Please fill out form completely and return to the school during school hours, or mail to:
Robin Tedeschi, 49 Blackberry Drive, Brewster, NY 10509. Please DO NOT mail to school address.
* * * * * * I prefer the AM PM session for 3 yr old 4 yr old .
| CHILD’S NAME | |
| PREFERRED NAME TO BE USED IN SCHOOL | |
| ADDRESS (Include Zip Code) | |
| PHONE | ( ) |
| BIRTH DATE | |
| PREVIOUS SCHOOL | |
| FATHER’S NAME | |
| Father's Religious affiliation | |
| MOTHER’S NAME | |
| Mother's Religious affiliation | |
| Marital Status of Parents |
| NAMES OF BROTHERS AND SISTERS | BIRTH DATES | ||
| 1. | 1. | ||
| 2. | 2. | ||
| 3. | 3. | ||
| 4. | 4. | ||
| PHYSICIAN | |
| PHYSICIAN'S PHONE | |
| List any allergies your child has (i.e. chocolate, egg white, milk, etc.) | |
| What does your child say when he or she wants to use the bathroom? | |
| If a boy, does child sit or stand? | |
| Does your child have any particular fears? | |
| What are your child’s favorite activities? | |
| Is your child left handed , right handed, not sure | |
| What are your reasons for wanting your child to attend nursery school? | |
| How did you learn of our school? (Please give names, if possible) | |
| List the name(s) of anyone who MAY NOT pick up your child from school |
MOTHER'S INFORMATION
| MOTHER’S OCCUPATION | |
| Business Address | |
| Business Phone | ( ) |
| Cell Phone | ( ) |
| If not presently employed, what occupational experience do you have? | |
| Mother’s hobbies and interests |
FATHER'S INFORMATION
| FATHER’S OCCUPATION | |
| Business Address | |
| Business Phone | ( ) |
| Cell Phone | ( ) |
| Father’s hobbies and interests |
*****Which school district will your child be in for public school? (Please indicate if you plan to have your child attend a private school)__________________________________________________
PLEASE RETURN APPLICATION PROMPTLY AS IT WILL BE DATED WHEN RECEIVED TO ASSURE PROPER ORDER OF ACCEPTANCE.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * In order for your child to attend field trips, we MUST have a signed permission slip.
I give permission for my child______________________________________ to attend and participate in any field trip for which he or she is eligible. I relieve the Brewster Co-op Nursery School, the Brewster Presbyterian Church, the teachers, staff and assisting parents of all responsibility in the event of an accident.
_____________________________
PARENT’S SIGNATURE