top of page
Log In
949-306-6938
Class Location:
Primrose School of Royal Palm Beach
Palm Beach County
HOME
BOOK NOW
ABOUT
STAFF
LOCATIONS
CONTACT
PRESS
TESTIMONIALS
SHOP
More
Use tab to navigate through the menu items.
Client Intake Forms
HOME
Parents Name
Parents Date of Birth
Child's Name
Email Address
Preschool
Child's Date of Birth
Phone
Pediatrician
Is your child taking any medication (murilax, fiber, etc.)
*
No
Yes
Is your child in a bed or crib?
*
Bed
Crib
If you answered yes, please elaborate
Has your pediatrician cleared your child for potty training?
*
No
Yes
Does your child have any special needs?
*
No
Yes
If you answered yes, please elaborate
Is your child in any type of OT, PT, or Early Intervention program for a developmental delay?
*
No
Yes
If you answered yes, please elaborate
Does your child have any special needs?
*
No
Yes
If you answered yes please elaborate
Does your child have constipation issues?
*
No
Yes
If you answered yes are you doing anything to help?
I declare that the info I’ve provided is accurate & complete
Medical Release
I agree to the terms & conditions of the Medical Release
Cancellation Policy
I agree to the terms & conditions of th Cancellation Policy
Ditch the Diaper Agreement
I agree to the terms & conditions of the Ditch the Diaper Agreemnt
Non Disclosure
I agree to the terms & conditions of the Non Disclosure
Your Signature
Clear
Select a date
Submit
bottom of page
