Child's First Name (required)

Child's Last Name (required)

Child's Nick Name (optional)

Child's Birthday (required)

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Current School

Parent's Name (required)

Parent's Phone (required)

Parent's 2nd Phone (required)

Parent's Email (required)

Address

Interested in
Full-time Preschool (M-F)Half-day Preschool (M-F)4-day/week Preschool (full-day)4-day/week Preschool (half-day)3-day/week Preschool (full-day)3-day/week Preschool(half-day)2-day/week Preschool (full-day)2-day/week Preschool (half-day)1-day/week Preschool (full-day)1-day/week Preschool (half-day)

*Starting in 2017, we will have a part-time bilingual preschool program (8:50am-11:50am M-F) to allow us taking in more children. Full-time space is still limited.

Please list any allergies or medical conditions that Quentz Bilingual Academy should be aware of:

When would you like your child to start

Are you flexible on the start date (Your child will have a better chance to get in if you are flexible on the start date)
YesNo

What kind of preschool would you like your child to attend

What would you like your child to accomplish through preschool years

We do a pre-evaluation of each child before he/she attends our school. Please bring your child with you for the school visit. What day/s of the week/what time during the day is the best for you to visit (Required)

How did you hear about Quentz bilingual preschool? (Required)
Registered with Quentz Bilingual beforeFrom someone (please enter the name in the following question)From a web searchFrom a local magazineFrom wechatFrom other (please specify below)

Enter the name of the person who referred you or if you choose "From other", please specify

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When you click on the button below, you will receive an email confirmation. We will contact you shortly for your visit.