page1
central nursery school
111 west wayne avenue, wayne, pa 19087
mail: p.o. box 15, wayne, pa 19087
info@cnsinc.org / 610-688-8563
2026 - 2027 School Year
REGISTRATION FORM
CHILD’S NAME:_________________________________________________________________________
First Last Nickname
Street Address_____________________________ City/State _______________________Zip _________
Child’s birth date __________________________ Gender ____________
MOTHER’S NAME:__________________________ FATHER’S NAME:___________________________
CELL PHONE NO.:__________________________ CELL PHONE NO.:__________________________
E-MAIL:__________________________________ E-MAIL:__________________________________
Names of Approved Pick-ups (other than parents): 1 ______________________________________
2 ______________________________________
ALLERGIES: ________________________________________________________________________
Previous Nursery School Experience:
Name of School ________________________________________ Number of Years Attended _____
PERMISSION: I give CNS permission to use my child’s photo in print, on the school
website and on the school’s social media pages.
Yes _____ NO _____
Does your child have any of the following?
Developmental Delays/Diagnosis (i.e. ASD, Sensory Disorder, Behavioral issues, etc.) : __________
_________________________________________________________________________________
_________________________________________________________________________________
Early Intervention Services: _________________________ County:__________________________
Speech/OT/PT Services: _____________________________________________________________
Other special needs: ________________________________________________________________
Custodial Agreement: _______________________________________________________________
If YES, the most recent documentation must accompany this form. CNS reserves the
right to dismiss a student if this information is not provided or disclosed at time
of registration.
Over -
www.cnsinc.org