Student's name:

M/F: Female Male

Date of Birth:

Current grade: Pre-K K

Current school (Name, City, State, Country):

Which Kindergarten Open House would you like to attend?

December 6th, 2007 January 10th, 2008 January 24th, 2008 February 7th, 2008

Parent name 1:

Parent address 1:

Parent telephone number 1:

Home:

Business:

Cell:

Fax:

Parent e-mail 1:

Parent name 2:

Parent address 2:

Parent telephone number 2:

Home:

Business:

Cell:

Fax:

Parent e-mail 2:

Person inquiring: Mother/ Father Stepmother/ father Aunt Uncle Brother Sister Consultant Student Guardian Other

If other, please specify:

How did you hear about Bement?

Are you interested in a viewbook and application? Yes No

Would you like to receive a financial aid application? Yes No

If you wish, please add additional comments below:

Please remember to click "Submit" when you are ready to send the form.

We look forward to seeing you!