Application - West Side Preschool - Enrollment Form

Please fill out application form, include a $75.00 non-refundable registration fee with this form,bring the completed enrollment form to West Side Preschool or mail to

West Side Preschool

429 High Street

Medford, Ma 02155

781 - 874 - 2169

Today's Date _________________Date of Tour__________________

New Student _________________Current Student_______________

Child's Name ___________________________________Sex______

Address________________________________________________

Home Phone____________________Cell Phone________________

Birthdate_______________________________________________

Parent/Gaurdian_________________________________________

Occupation_______________________Work Phone_____________

Parent/Guardian_________________________________________

Occupation_______________________Work Phone_____________

Email __________________________________________________

Preferred Program:

2 Day 8:00 - 1:00____8:00 - 2:00____ 8:00 - 3:00____

3 Day 8:00 - 1:00____8:00 - 2:00____ 8:00 - 3:00____

4 Day 8:00 - 1:00____8:00 - 2:00____ 8:00 - 3:00____

5 Day 8:00 - 1:00____8:00 - 2:00____ 8:00 - 3:00____

(If you want a 9:00 start time just write it in please.)

At West Side Preschool we will make every effort to accommodate and meet the needs of every family. To arrange for a particular schedule of day's or time's not listed above,please call 781-874-2169.

~Inquire About Our Summer Sessions~