If you are the parent of a preschool child and have not notified the school of your child’s name and birth date, please
complete the form below and return it with your child or call the Burton Street School Office at 655-1325 as soon as
possible. Your cooperation is greatly appreciated.

Parent’s Name: ______________________ Phone Number:_____________

Address: ___________________________

__________________________________

Names of Preschoolers:

Date of Birth:

_________________________________

_______________________

_________________________________

_______________________

_________________________________

_______________________

_________________________________

_______________________
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