Pre-Registration Form Parent Information Parent Name * Parent Phone Number * Parent Email Address * Employment Information Are you or your spouse an employee of Piedmont Athens Regional?Employment will be verified to ensure employees are given priority placementYesNo Employee's Name What is the employment status at Piedmont Athens Regional?Employment status will be verified if requesting placement in a variable slotNoneFull TimePart TimePRN Piedmont Athens Regional Employee ID Number Child Information Child's Name* Child's Birthdate* Schedule Date that childcare needs to start * Please prove you are human by selecting the plane. Please leave this field empty.
