Today’s Date __________________ Registration for Fall □  Spring □  2_______

Child’s Name_______________________________________________________________

Parent’s Name ______________________________________________________________

Child’s Date of Birth _______/_________/________

Address _____________________________________________________________________

Phone # ________________________________ Cell # _______________________________

1) Does your child have siblings at home? Yes □ or No □ If yes, include names and

ages: _______________________________________________________________________

2) What is your status at Rhode Island College? Faculty □ Student □ Staff □

3) Do you have any special talents, interests or skills? __________________________

4) Is your child toilet trained? Yes □ or No □

5) What language is spoken at home? _________________________________________

6) Who is the child’s primary care giver? _______________________________________

7) Are there any special circumstances that the teacher should be aware of?

Explain: ________________________________________________________________

8) Does your child have any medical problems, allergies or special needs?

Explain: _________________________________________________________