Application for School Year Apply Online Child's Full Name:(*) Date of Birth:(*) Home Address:(*) Home Phone Mother's Name:(*) My Child Calls Me: Cell Phone: Email address(*) Occupation: Business Address: Work Phone:(*) Father's Name:(*) My Child Calls Me: Cell Phone:(*) Email address(*) Occupation:(*) Business Address Work Phone: Sibling: Age: Sibling: Age: Parents Marital Status: Does the child live with both natural parents? Emergency Contact: (In event parent can not be reached) Name: Phone Relation to Child: Pediatrician: Address: Phone: Alergies About Your Child For snack my child likes to eat: For lunch my child likes to eat: My child loves to: When child is upset, what calms him/her down? Language(s) spoken at home: Language(s) spoken by child: How does your child respond to new situations: Any other information you would like us to know about your child: How did you hear about our Preschool? This field should be left blank Send Please wait...