Flight Academy Pre-K Enrollment

Today's Date: ____/_____/2025

CHILD’S INFORMATION

Full Name: Preferred Name/Nickname:

Date of Birth: SS# (last 4):

Address:

Age:

(Must have turned three before Sept 1, 2025, and must turn five after Sept. 1, 2025) [cite: 6]

Is your child fully potty-trained? (Required) Yes No

Does your child have any allergies? Yes No
If yes, to what:

Does your child have any medical Concerns? Yes No
If yes, list them:

Primary Care Doctor: Phone Number:

Preferred Hospital:

PARENT/GUARDIAN INFORMATION (1)

Name:

Phone Number(s):

Address:

Email:

PARENT/GUARDIAN INFORMATION (2)

Name:

Phone Number:

Address:

Email:

Emergency Contact

Name and Number:

AUTHORIZED PICK-UP LIST

Person 1:

Name on ID: Relationship:

Person 2:

Name on ID: Relationship:

Submission

By submitting this form, you attest that the information provided is accurate.

Printed Name: Signature (Type your name to sign):