EmailMe Form - 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.