GA Pre-K Enrollment Form

Georgia Pre-K Program Waiting List Information Form

Date

Child's Last Name

Child's First Name

Name Suffix (Jr, Sr, II, III)

Child's Date of Birth

Gender

Male

Female

Last 4 Digits of SSN

Address

County of Residence

Parent/Guardian Name

Preferred Phone Number

Additional Phone Number

Email Address

Preferred Method of Communication

Phone Call

Text Message

Cell Phone Number

Information provided on this form is shared with Georgia Department of Early Care and Learning for the purpose of maintaining a state level waiting list for Georgia's Pre-K Program. By Completing this form and signing below you consent to the sharing of this information.

Signature

Date

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