Last Name  First Name used:  

Address:  Email:

City: Zip:

 Home No.:    Work No.:    Cell No.: 

Child's Birthdate:

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Check Class Registering for:  PMO (1 or 2 days)    2 yr. (3 or 5 days)   3 yr. (3 or 5 days)   Pre-K

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Payment:  Please mail registration fees to:  Harmony Grove Preschool, 50 Harmony Grove Rd., Lilburn, Ga 30047

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Physical Record:

List any allergies, reactions to medication or foods, or other special needs:

Are bathroom habits well established?  Yes   No

Physical Disabilities:

Has your child ever had a psychological or educational evaluation?   Yes  No

List medications given on a regular basis:

List any foods your child cannot eat:

 

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Social Relationships:

Has your child had experience in playing with other children? Please explain in detail:

As yet, does your child favor use of his/her right or left hand?   Right Hand    Left Hand

 

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Special Information:

Special Information:Is there any significant information you might add which would further contribute to a better understanding of your child and his/her needs? (For example: difficulty sharing, very active)

What do you hope your child will gain from a year at Harmony Grove:

 

Disclaimer: As a non-profit school, we reserve the right to not accept your child in our program if this is not the best placement for your child due to budgeting constraints which prevent the hiring of additional staff.