Application Form (2021-2022 School Year)
Application to Miss Cheyenne's Pre-K Academy, LLC
(Note: filling out an application does not guarantee enrollment)
Email address *
Do you intend to have your child enrolled in school for the entire school year (September 1st, 2021-June 10th, 2022)? If not, please explain. *
Child's Full Name *
Your Child's Preferred Name/Nickname *
Child's Date of Birth (Pre-K students must turn 4 by 9/1/2021, TK 5 by 12/31, K 5 by 9/1): *
Parent/Guardian Name(s): *
Home Address *
Best Contact Number *
What type of school experience has your child participated in? (ex: daycare, church program, library story time, etc.) *
Is your child fully potty trained? Fully potty-trained is defined by as a child being able to go through the entire day without wetting or soiling themselves and not needing a diaper or pull-up at anytime during the day (including rest-time). The fully potty-trained child is also completely independent for knowing when to go to the bathroom, and does not need assistance inside the bathroom such as getting on or off the toilet, pulling pants up or down, redressing and wiping. Children who are determined to not be potty-trained will be dismissed from the program. *
Is English the main language spoken in your home? *
If your answer was "no" to the above answer, what other languages are spoken in your home? (type "N/A" if this question does not apply to you.) *
Does your child understand the above language(s)? (select "N/A" if this question does not apply to you.) *
Required
Is your child understood by people outside of your family when he/she speaks? *
Does your child currently receive, or has your child ever received special education services (ex: speech/language therapy, occupational therapy)? *
If your answer was yes to the above answer, please explain. (type "N/A" if this question does not apply to you.) *
What was your child's weight at birth? *
Was your child premature? *
If your answer was yes to the above question, how many weeks premature? (type "N/A" if this question does not apply to you.) *
Has your child ever experienced a serious injury or have any medical issues that may impact him/her at school? *
If your answer was yes to the above question, please explain. (type "N/A" if this question does not apply to you.) *
Is your child on any long-term medication? *
If your answer was yes to the above question, please explain. (type "N/A" if this question does not apply to you.) *
Does your child have any brothers or sisters who have experienced learning difficulties? *
If your answer was yes to the above question, please explain. (type "N/A" if this question does not apply to you.) *
Has your child ever been expelled from a daycare or school setting? *
If your answer was yes to the above question, please explain. (type "N/A" if this question does not apply to you.) *
How did you hear about us? (example: Facebook, current/past MCPKA family, google, etc.) *
Which HCPSS school will your child attend kindergarten/first grade (please also indicate county if not in Howard County)? *
What priorities do you have for your child this year? *
Which program are you interested in? *
Required
Desired Attendance Days (note: extended hours are not offered): *
Required
I hereby certify that the above information is true and correct. I understand that this information is being given for consideration of placement to Miss Cheyenne's Pre-K Academy and does not guarantee enrollment. Please type out your full name. *
I understand that by typing my name and clicking on "submit", that I am electronically signing this document. *
Required
A copy of your responses will be emailed to the address you provided.
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