Regina Krieger Is the Education Director/Lead Teacher at Discovery MI School in Scranton

APPLICATION FOR ENROLLMENT – 2016/17

Please complete the attached form and return it along with the $35 registration fee to Discovery MI Preschool 738 Taylor Ave Scranton PA 18510

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

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 MI Preschool will do its best to accommodate preferences for half day sessions but is unable to guarantee entrance into a particular session until enrolment is complete.

Discovery MI Preschool 1301 Beech St Scranton PA 18504 www.mydiscoverypreschool.org