Fergus Falls Public Schools #544

Otter Preschool – School Readiness …where your child’s educational journey begins Return to: ISD 544 Otter Preschool-School Readiness Early Childhood Center @ 1519 Pebble Lake Road 218-998-0544, ext. 9529 Or mail to: 601 Randolph Ave Fergus Falls, MN 56537

First ______________Middle_____________Last______________ DOB: ________ Gender: ___F___M (Child’s full legal name) (Age 3 years by Sept. 1st) Early Childhood Screening Completed: _____________(date) Follow-up required? ____________ Is your child receiving special services? If so, explain. _____________________________________ Parent(s) Guardian(s) Information Name: ______________________________________

Relationship to child _____________________

Address: ____________________________________

City/State/Zip ___________________________

Address same as child: ______________________

Phone (H): ______________________________

Phone (W): __________________________________

E-mail___________________________________

Name: ______________________________________

Relationship to child _____________________

Address: ____________________________________

City/State/Zip ___________________________

Address same as child: ______________________

Phone (H): ______________________________

Phone (W): __________________________________

E-mail___________________________________

Program Preference Session: AM ____ 8:30-11:30 am PM ____ 12:30-3:30 pm

Days: ________ 2 x/wk – Monday & Wednesday ________ 2 x/wk – Tuesday & Thursday ________ 4 x/wk – Monday through Thursday

FEES: 2x/wk = $90/mo 4x/wk = $180/mo; reduced fee options available Request Reduced Fee Information _______ Early Learning Scholarship _______ Parent/Guardian Signature ________________________________________ Date: ________________

Date Received: ____________________

$30 Registration Fee: __________________________