532 Country Day Road

Goldsboro, NC, 27530

919-735-9056

Protestant Preschool & Kindergarten

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2018-2019 Student Registration Information Form

Parent Name *

Parent Name

First Name

Last Name

Name-Student 1 *

Name-Student 1

First Name

Last Name

Birthday-Student 1 *

Birthday-Student 1

MM

DD

YYYY

Name-Student 2

Name-Student 2

First Name

Last Name

Birthday-Student 2

Birthday-Student 2

MM

DD

YYYY

Phone *

Phone

(###)

###

####

Parent Email *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country