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Lavender Hill Preschool Application
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Email Address *
Schedule preferences
Anticipated date of enrollment *
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How many days would you like your child to attend *
What is your first schedule preference? *
Required
What is your second schedule preference? *
Required
Contact information
Child’s Name *
Child’s Date of Birth *
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Child’s Gender *
First Parent Full Name *
First Parent Email Address *
First Parent Phone Number *
First Parent Street Address *
First Parent City of Residence *
First Parent State and  Zip code *
First Parent’s Employer *
Work address
Work phone number
Second Parent Full Name
Second Parent Email Address
Second Parent Phone Number
Second Parent Street Address
Second Parent City, State and Zip code
Second Parent Employer
Second Parent Work Address
Second Parent Work Phone
Siblings - Please list siblings name, date of birth, and gender
Family Questionnaire
Please describe the pregnancy and birth ( i.e. c-section, complications during pregnancy and birth, adoption, etc). *
Please give a description of your home situation and daily rhythm. *
What types of family activities do you enjoy together? *
Please describe your child's current or past day care or school experience, if any. *
Do you have any concerns about your child from past day care, school, or group experience? Please describe. *
Please describe your child's strengths. *
Please describe any aspect of your child's personality you'd like to see strengthened. *
Please comment on your child's like and dislikes, special circumstances or experiences, fears, etc. *
Please describe how your child plays with other children. *
Please describe how your child plays alone. *
What types of food does your child like to eat? *
Screen Time and Media
How much time, on average, does your child spend on the following?
Listening to radio, records, tapes - per week? *
Watching TV, VCR/DVD, movies - per week? *
Playing computer games - per week? *
We ask that you consider your child’s viewing habits in light of the increasing evidence of its adverse effects on children and their development. (A reading list is available upon request.) Are you willing to change your child’s television viewing habits if your teacher feels it would benefit your child? Please answer as fully as you are able. *
Develomental Milestones
Please let us know at what age your child accomplished the following milestones.
Crawl *
Sit up *
Walk *
First tooth *
First word *
Speak in 4-5 word sentences *
Please describe your child's development regarding the following:
Putting on shoes, coats, and pulling up pants *
Toilet training (In general, our expectation is that children over the age of three are toilet trained. If your child is having developmental or medical issues that delay toilet training, please be sure to inform us.)
Medical History
What illnesses has your child had, particularly including measles, mumps, diphtheria, rubella, shigella, hepatitis (type?), meningitis (type?), salmonella, chicken pox, or giardia? *
Does your child have any allergies or health issues? *
Other
Why are you considering Waldorf education for your child? *
Have you attended an in-person Open house *
How did you hear about this program? If you found us on the web, which websites and search engines, and what words did you search on? *
Anything else you would like to add?
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