Rosen Family Preschool, Hearing Speech and Deaf Center Online Registration

Registration

Already a customer? Click here to login.

Thank you for your interest in Early Childhood Education at Seattle's Hearing Speech and Deaf Center! Please complete this form to apply for enrollment. We will set up a follow-up appointment to review your child's placement in our program.

If you have any questions, please reach out to us at rosenpreschool@HSDC.org.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Account Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Please list name and age of sibling(s)*

List Home Language(s)*

Any interpreting requests?

Any accessibility needs?

VP Number:

Special skills or interests: *

Contact #1

First Name*

Last Name *

How Can We Contact You?

Home Phone *

Work # *

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

First Name

Last Name

How can we contact you?

Home Phone

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

Any chronic or life-threatening illnesses we should be aware of?*

Grade Level*

Please share student's accessibility needs:*

Why are you interested in our program?*

How does your child identify: Deaf/Hearing/HH/KODA/SODA/Unilaterally Deaf/Other*

Allergies & Dietary Restrictions*

Medications*

Physician Name and Phone/Dentist Name and Phone*

Immunization Notes*

Student's Primary Language*

Home School District*

Do you have an IEP /IFSP?*

Do you use ASL at home? *

Is child Deaf/hard of hearing?*

Please click on the Search button below, then choose the class you want.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

Any chronic or life-threatening illnesses we should be aware of?*

Grade Level*

Please share student's accessibility needs:*

Why are you interested in our program?*

How does your child identify: Deaf/Hearing/HH/KODA/SODA/Unilaterally Deaf/Other*

Allergies & Dietary Restrictions*

Medications*

Physician Name and Phone/Dentist Name and Phone*

Immunization Notes*

Student's Primary Language*

Home School District*

Do you have an IEP /IFSP?*

Do you use ASL at home? *

Is child Deaf/hard of hearing?*

Please click on the Search button below, then choose the class you want.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

Any chronic or life-threatening illnesses we should be aware of?*

Grade Level*

Please share student's accessibility needs:*

Why are you interested in our program?*

How does your child identify: Deaf/Hearing/HH/KODA/SODA/Unilaterally Deaf/Other*

Allergies & Dietary Restrictions*

Medications*

Physician Name and Phone/Dentist Name and Phone*

Immunization Notes*

Student's Primary Language*

Home School District*

Do you have an IEP /IFSP?*

Do you use ASL at home? *

Is child Deaf/hard of hearing?*

Please click on the Search button below, then choose the class you want.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

Any chronic or life-threatening illnesses we should be aware of?*

Grade Level*

Please share student's accessibility needs:*

Why are you interested in our program?*

How does your child identify: Deaf/Hearing/HH/KODA/SODA/Unilaterally Deaf/Other*

Allergies & Dietary Restrictions*

Medications*

Physician Name and Phone/Dentist Name and Phone*

Immunization Notes*

Student's Primary Language*

Home School District*

Do you have an IEP /IFSP?*

Do you use ASL at home? *

Is child Deaf/hard of hearing?*

Please click on the Search button below, then choose the class you want.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

Any chronic or life-threatening illnesses we should be aware of?*

Grade Level*

Please share student's accessibility needs:*

Why are you interested in our program?*

How does your child identify: Deaf/Hearing/HH/KODA/SODA/Unilaterally Deaf/Other*

Allergies & Dietary Restrictions*

Medications*

Physician Name and Phone/Dentist Name and Phone*

Immunization Notes*

Student's Primary Language*

Home School District*

Do you have an IEP /IFSP?*

Do you use ASL at home? *

Is child Deaf/hard of hearing?*

Please click on the Search button below, then choose the class you want.

Enroll in Classes

Select Class *

Add Another Student