Regina Krieger is the Education Director/Lead Teacher at ...



APPLICATION FOR ENROLLMENT – 2017/18

Please complete the attached form and return it along with the $35 registration fee to

Discovery MI Preschool

1301 Beech St

Scranton PA 18505

|Student’s First Name | |

|Student’s surname | |

|Date of Birth | |

|Age on September 1, | |

|Home address | |

| | |

| | |

|City |State |Zip |

|School District | |

|Mother’s Name | |

|Home Address | |

|Home Address | |

|City |State |Zip |

|Telephone | |

|Cell phone | |

|Work Phone | |

|Email | |

|Father’s Name | |

|Home Address | |

|Home Address | |

|City |State |Zip |

|Telephone | |

|Cell phone | |

|Work phone | |

Please tick as appropriate

| |I would like to apply for enrollment in the full day program |

| |I would like to apply for enrollment in the morning only program |

| |I would like to apply for enrollment in the afternoon only program |

Discovery Multiple Intelligences Preschool admits students of any race, color, national and ethnic origin to all the rights, privileges, programs , and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies , admissions policies , scholarship and loan programs , and other school-administered

programs.

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