Enroll Preschool — Country Learning Center

Child’s Information

Please fill out the form below.

Child's Name

First Name

Last Name

Date of Birth

YYYY

Parent's Name

First Name

Last Name

Phone

(###)

###

####

Parent's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What school year and class (3yo or 4yo) are you wanting your child to start?

Example: August 2023

Questions or Comments

Fully Potty Trained

Public School PreK Screening

(If Yes, please provide any concerns from that visit)

Academic Related Concerns

Behavior Related Concerns

How did you hear about us?

To secure your child’s spot, a non-refundable deposit to CLC will be due no later than April 7, 2023. This fee ensures the number of students attending and is utilized towards facility and insurance coverages required by DCFS.