Parent Record of Intent – Preschool Placement Preference (PDC100)

Email *

Parent/Guardian Full Name *

Phone Number *

Home Address *

Child’s Full Legal Name

Child’s Date of Birth *

Placement Preference Declaration * I am requesting Paterson Day Care 100 (PDC100) as my preferred preschool placement for my child. I request confirmation of seat availability at PDC100 before any reassignment occurs. I authorize PDC100 to communicate with Paterson Public Schools regarding my child’s placement request. I understand that placement at PDC100 is subject to program capacity and availability.

All four boxes must be checked to submit.

Digital Signature (Type Full Name)

Today’s Date

By submitting, you confirm the information is accurate.

Placement Preference

Parent Record of Intent – Placement Preference

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