Cornerstone Preschool Online Registration

Registration

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Welcome to Cornerstone Preschool!

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contacts and Phone Numbers*

Names and Ages of Siblings

Persons Authorized to Pick Up*

Contact #1

Contact #1 First Name*

Last Name *

Relation to Child*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relation to Child

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Special Needs (or NONE)

Allergies (or NONE)*

Medications (or NONE)*

Primary Doctor & Phone Number*

Immunization Notes

Name Child Goes By

Please click on the Select Class button below, then choose the class you wish for your student.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Special Needs (or NONE)

Allergies (or NONE)*

Medications (or NONE)*

Primary Doctor & Phone Number*

Immunization Notes

Name Child Goes By

Please click on the Select Class button below, then choose the class you wish for your student.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Special Needs (or NONE)

Allergies (or NONE)*

Medications (or NONE)*

Primary Doctor & Phone Number*

Immunization Notes

Name Child Goes By

Please click on the Select Class button below, then choose the class you wish for your student.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Special Needs (or NONE)

Allergies (or NONE)*

Medications (or NONE)*

Primary Doctor & Phone Number*

Immunization Notes

Name Child Goes By

Please click on the Select Class button below, then choose the class you wish for your student.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender

Birth Date*

Additional Info

Special Needs (or NONE)

Allergies (or NONE)*

Medications (or NONE)*

Primary Doctor & Phone Number*

Immunization Notes

Name Child Goes By

Please click on the Select Class button below, then choose the class you wish for your student.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Emergency Medical Treatment Form

I've read the above and agree.

Certificate of Immunization

I've read the above and agree.

Enrichment and Registration Fees

I've read the above and agree.

Tuition Payment Policy

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name* May 20, 2024

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)