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ICC Preschool Wait-list Form 2016
Child's Name
*
First
Last
Child's Age
*
3 - 4 Years
4 - 5 Years
Parent/Guardian of the Child
Parent/Guardian's Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
###
-
###
-
####
Email
*
Is your child potty trained?
*
How did you hear about our school?
*
*
Yes, I agree
By joining or registering for ICC programs, you agree to release and hold harmless organizers from and against any claim, loss, damage, liability, expense, impairment or cause of action arising out of or related to your participation.