Falls Church Extended Care Sign-up Form

  • Child's Information

  • MM slash DD slash YYYY
  • Family Information

  • Sibling information

  • Emergency Contact If Parents Cannot Be Reached

  • Person(s) Authorized to Pick up Child

  • Person(s) NOT Authorized to Pick-up Child

  • Communications

    We communicate via e-mail much of the time. Please list any and all address(es) to which you would like Communikids Preschool & Children's Language Center to be delivered:
  • Do you give permission to CommuniKids Preschool to include your contact information in our school directory for release to fellow CommuniKids Preschool parents?

  • Please initial that all the above information is true:

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