Neptune Township School District

Kathleen Thomsen, Early Childhood Supervisor

60 Neptune Blvd., Neptune, New Jersey 07753
kthomsen@neptune.k12.nj.us

2021-22 Preschool Program Acceptance Form

Dear Parent(s):
Please complete and return to the address noted above.

CHILD’S NAME __________________________________BIRTH DATE_________________

STREET ADDRESS____________________________________________________________

CITY ____________________________ STATE__________________ZIP________________

PHONE # ___________________________ CELL PHONE #_____________________

EMAIL ADDRESS______________________________________________________________

EMERGENCY PHONE # ___________ NAME OF EMERGENCY CONTACT______________

ASSIGNED SCHOOL___________________________________________________________

Check One

_____ Yes, I will enroll my child in the Preschool Program for the 2021-22 school year.

_____ No, I will not enroll my child in the Preschool Program for the 2021-22 school year.

Print Parent’s Name __________________________________________

Parent’s Signature & Date______________________________________

If you are interested in any before/after care services please contact the following:
Champions Extended Learning: 732-776-2200, Ext. 3305 or discoverchampions.com

Important: In order for us to assign the correct bus stop, please indicate pick-up/drop-off address
if different from home address:

Pick-Up:

Drop-Off:

Note: All transportation changes must be given to the Transportation Office by August 15, 2021
by calling 732-776-2200, Ext. 3631.
Revised 2015