Preschool

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About Us
Parent and Student Resources
Apply
- K-8th Grade

WHITE PINE ACADEMY

Home
About Us
Parent and Student Resources
Apply
- K-8th Grade

White Pine Academy
Application For Admission (Preschool)

Student Information (Preschool)

* Indicates required field

Name *

First

Last

Age *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Place of Birth *

Home Phone Number *

Emergency Contact Person *

Emergency Contact Phone Number *

Parent/Guardian Information

Father/Guardian Name *

First

Last

Present Address *

Line 1

Line 2

City

State

Zip Code

Country

Father/Guardian

Home Phone Number *

Father/Guardian

Cell Phone Number *

Father/Guardian

Email *

Father/Guardian

Mother/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother/Guardian

Home Phone Number *

Mother/Guardian

Cell Phone Number *

Mother/Guardian

Email *

Mother/Guardian

If you affirm the above information to be true and accurate, initial and date the lines below.

Initial *

Date *

Days attending the program.

Monday *

Half Day Full Day