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Application

This document is an application for First Presbyterian Kindergarten and Preschool. It requests information about the child such as name, date of birth, address, previous school, and contact information for parents. It asks which class the parents are interested in enrolling the child in, including options for 1, 2, or 3-year-old classes as well as pre-K, kindergarten, and extended day programs. Sections also request information about the child's siblings, health, physicians, emergency contacts, behaviors, interests, and permissions for emergency treatment and photographs. The final section is for office use only regarding the acceptance date and fees paid.

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52 views

Application

This document is an application for First Presbyterian Kindergarten and Preschool. It requests information about the child such as name, date of birth, address, previous school, and contact information for parents. It asks which class the parents are interested in enrolling the child in, including options for 1, 2, or 3-year-old classes as well as pre-K, kindergarten, and extended day programs. Sections also request information about the child's siblings, health, physicians, emergency contacts, behaviors, interests, and permissions for emergency treatment and photographs. The final section is for office use only regarding the acceptance date and fees paid.

Uploaded by

api-107554386
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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First Presbyterian Kindergarten and Preschool

Application
This information is confidential and will be used by the Director and Teachers only.
Name of child____________________________________________Sex____________
Name preferred to be used_________________________Date of Birth______________
Address_________________________________________________________________
Home Phone_________________________Cell Phone___________________________
Previous school attended____________________________________________________
Name of person other than parent to pick up child________________________________
________________________________________________________________________
Please check the class you are interested in for your child:
One-Year-Old ___Two- Year- Old ___Three- Year- Old ___

3 day ___0r 5 day___

Pre-K___ Kindergarten ___ K or Pre-K with extended day ____


T.O.T. S __________
Mother:

Name_______________________________________________________
Address_____________________________________________________
Occupation________________Place of Employment_________________
Business Phone_______________________________________________
Business Address_____________________________________________

Father:

Name_______________________________________________________
Address_____________________________________________________
Occupation________________Place of Employment_________________
Business Phone_______________________________________________
Business Address_____________________________________________

Siblings:

Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________

Others living in the home (Please give relation as well as name):____________________

Are your childs regular playmates his age?_____ Older____Younger___Same Sex_____


Does your child have a pet?________What?____________________________________
Give all the information you can on the following:
Fears_______________________________________________________
____________________________________________________________
Behavior habits (biting nails, thumb sucking, tantrums, etc.)___________
____________________________________________________________
____________________________________________________________
Areas in which your child may need special help or attention:______________________
____________________________________________________________
____________________________________________________________
Any additional information which you think would be helpful?_____________________
____________________________________________________________
____________________________________________________________

Please note: A $90 fee is due at the time of registration, along with a $55 supply fee
for 3 year old students and a $65 supply fee for 4 and 5 year old students.
Refundable through June 1.

Physical Record:
Allergies?

____________________________________________________________
____________________________________________________________
How does it manifest itself?_____________________________________
____________________________________________________________

What serious illness, if any, has your child had?_________________________________


____________________________________________________________
Name of childs physician_________________________Phone____________________
Name of family physician or second choice_____________________________________
In an emergency, whom may we call if unable to reach the parent? Must list two!!
Name____________________________________Phone____________________
Relationship_______________________________________________________
Name____________________________________Phone____________________
Relationship_______________________________________________________

Permissions
(Please check and sign)
_____Permission is given for emergency medical treatment to be obtained for my child.
_____Permission is given for my child to make local field trips during school hours.
_____Permission to have my child photographed for, but not limited to, use in
advertising, articles in the newspaper, or for preparing memory books.
Signed:________________________________
(Parent or guardian)

FOR OFFICE USE ONLY


Date of Acceptance________________________
Reg. Fee Paid________Supply Fee Paid_______

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