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If you are interested in enrolling your child in our preschool please complete
the online form below and someone from our school will be in touch.
* = required field.

    Child Information

    Child's Name: *

    Gender: *

    Date of Birth: *

    Enrollment Date: *

    Home Phone #: *

    Address: *

    City: *

    State: *

    Zip Code: *

    Age Group: *

    Parent/Guardian Information

    Child Lives With: *
    Both ParentsMotherFatherGuardian

    Mother's Name: *

    Mother's Work #: *

    Mother's Cell #: *

    Mother's Email: *

    Father's Name: *

    Father's Work #: *

    Father's Cell #: *

    Father's Email: *

    Person(s) permitted to remove child
    from Preschool Facility:

    **Any individual permitted to remove child from PCACC must set up their profile in our enhanced security system, a touch screen/fingerprint scan.

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