Step 2 of 3 — Child Intake Form

Tell us about your child

Required after registration. Takes about 5 minutes.

Child information

Child full name *

Date of birth *

Gender (optional)

Primary language(s) *

Home address *

Allergies (food/medical)

Medical conditions

Dietary restrictions

Emergency contact

Emergency contact name *

Emergency contact phone *

Authorized pickup persons (name + phone) *

Parent / guardian information

Parent/guardian name(s) *

Phone number(s) *

Email *

Employer (optional)

Program preferences

Program length *

2 hours/day

$550/month

4 hours/day

$1,000/month

Preferred session time *

8:30 AM – 10:29 AM10:30 AM – 12:29 PM1:30 PM – 3:29 PM3:30 PM – 5:29 PM

Second choice session time (optional)

What are your top 1–3 goals for your child? *

Examples: Early literacy, Social confidence, Healthy routines, Behavior, Communication, Creativity

AgreementsI have read and agree to I.HHWWA Preschool's enrollment policies, billing terms, and program guidelines. *I give permission for my child to be photographed or filmed for I.HHWWA Preschool's educational and promotional use (optional).

We will contact you within 1 business day to confirm your start month and schedule a tour.

Your information is kept private and used only for enrollment purposes.