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615-814-2207 | 537 Franklin Rd Building C, Franklin, TN 37069
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1-4+ Year Old Info Form

1-4+ Years Info Form

This form is for children born between January 2021 and February 2025

"*" indicates required fields

Child's Information

Child's Full Name*
MM slash DD slash YYYY
Child's Primary Address*

Parent Information

Guardian 1's Information:

Guardian 1's Name*
Is Guardian 1's address the same as the child's?*
Guardian 1's Address

Guardian 2's Information:

Guardian 2's Name*
Is Guardian 2's address the same as the child's?*
Guardian 2's Address

Family Information

Do you have a current domestic relations order or parenting plan governing custody of the child?*
If the family has a domestic relations order or parenting plan governing custody or care of the child, we must have a copy of this order or parenting plan. If for any reason the noncustodial parent is not allowed visitation rights and does not have the right to remove the child from school, we must have a legal document from the custodial parent to support this order. These documents must be received by your child's school before he or she will be enrolled. You are responsible for notifying the school if these plans change. Please be sure any legal documents pertaining to child custody or care on file with your child's school are current at all times.
Do both parents have custody?*
List any sibling name(s) and age(s)*

Traits & Personality

Does your child use:*
Check all that apply.
Does your child cry easily?*
Is it easy for your child to be separated from parents/guardians?*
Children enrolled in our 3-year-old classrooms must be fully potty trained and toilet independent by their 3rd birthday. If your child is 3 years old or older, please acknowledge that they are fully potty trained.*
If your child participates in Extended Fun, ClearView Prep will provide an after-school snack of Veggie Straws. Please check the box below to acknowledge and consent to your child receiving this snack.*

Medical Information

Does your child have any allergies?*
Does your child have an EpiPen? If yes, CV Prep will need to have an extra one. Doctor's instructions must be included.*
Has your child ever been evaluated for:*
Did these evaluations end with services or a diagnosis?*
Has your child ever been treated for behavioral or psychological reasons?*

Emergency Information

Emergency Contact Name*
MM slash DD slash YYYY

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