Peer Model Preschool Application
Thank you for your interest in the Canal Winchester Preschool Program. Please complete this form and click the submit button at the bottom to apply for our program. If you have any questions, please contact Maleea Anderson, Preschool Coordinator, 614-920-2757. Completing this form will register your child for Child Check. Child Check is scheduled throughout the school year. Following the completion of this form, your information will be saved until the upcoming Child Check date. Near the scheduled Child Check, the Preschool Coordinator will contact you to schedule your appointment time. Thank you!
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Nickname:
Your answer
Child is
Child's Date of Birth (mm/dd/yyyy) *
Your child must be 4 years old to be considered for the Peer Model Program.
Your answer
Address *
You and your child must reside within the Canal Winchester Local School District
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Mother/Guardian's Name *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Father/Guardian's Name *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Do you suspect any problems with your child's development? *
If you answered Yes or Not sure, please list your concerns.
Your answer
Please complete the section below by marking check all that apply. *
Required
Describe your child's strengths.
Your answer
List other preschool experiences your child has had:
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Primary language spoken by the child: *
Your answer
Primary language spoken in the home
Your answer
When playing with friends, how does your child participate. Please check all that apply. *
Required
Please select your preference for preschool *
Should your child be accepted into the preschool program, we will do our best to accommodate. However, it is not guaranteed.
Kindergarten Start Date *
Please indicate the year you anticipate your child to start kindergarten. Please be aware that children must be age 5 by August 1st in order to start kindergarten.
If my child is accepted as a peer model, I agree to pay the established tuition of $100.00 for 9 payments, due on the 25th day of the preceding month with the first's month' tuition to be made by the first day of your child's start date. *
If my child is accepted as a peer model, I understand I am required to provide transportation for my child to and from school. *
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