2024-2025 Galloway Township Preschool Lottery
IMPORTANT NOTES:

1.  Please read the first question carefully to determine the number of forms to complete if you have more than one eligible child.  Duplicates will be removed.

2. The email address and phone number you provide will be utilized for notification purposes.

3. If selected, all information included on this form will be verified during the enrollment process.
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Email *
Do you have MORE THAN ONE child eligible for Preschool?  (Eligible students are 3 or 4 on or before 10/1/24.) *
Child's Full FIRST Name on Birth Certificate (If multiple births, list all FIRST names.) *
Child's Full LAST Name on Birth Certificate *
Child's Date of Birth (Must be 3 or 4 years old by 10/1/24 - Please enter the CORRECT year of your child's birth from the birth certificate.) *
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Please RE-ENTER your Child's Date of Birth   (Must be 3 or 4 years old by 10/1/24 - Please enter the CORRECT year of your child's birth from the birth certificate.) *
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YYYY
Does your child have any significant health concerns? *
If you answered YES to prior question, please indicate your child's significant health concern(s) below.  (Skip this question if your child has NO significant health concerns.)
What is the primary language spoken in the home? *
Parent/Guardian FIRST Name (Please use name of PRIMARY contact.) *
Parent/Guardian LAST Name *
Address  (Number and Street) *
City (Must be a resident of Galloway Township) *
10 Digit Phone Number (This number will be used for notification purposes.) *
Please Include the Area Code
School &/or daycare previously attended (if any)
Will you have other school-aged (PK-8) children attending Galloway Schools in the 24-25 school year? *
If YES to the above, what school(s) will your other children attend for the 24-25 school year? (Click all that apply)
If applicable, please provide the full name(s) of your other children who will be attending Galloway Schools for the 24-25 School Year.  
Household/Family Size (Parent/Guardian(s) and children/adults providing for in your home.) *
Choose One
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Row 1
Annual Income Range - for Parent/Guardian(s) *
Before and/or after school child care will be available.  Please indicate if your child may use this service.   (This is an additional cost which is the responsibility of parent/guardian.  See Preschool Q&A Sheet for more info.) *
Do you plan to use school provided transportation (buses)?  *
How did you hear about the preschool program? Check all that apply: *
Required
Please read the following statement and click "Confirm":   Email confirmation of this submission for the Preschool Lottery will come via Google Forms (not a district email). Please look for this confirmation email after clicking "Submit". Thank you. *
Required
A copy of your responses will be emailed to the address you provided.
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