Preschool/Kindergarten Application
(Ages 30 months to 6 years)
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 for the morning program (8:30am - 12:30pm)? *
Required
What is your second schedule preference for the morning program (8:30am - 12:30pm)? *
Required
Please indicate the days you will need After Care (12:30 - 4:00). *
Required
Contact Information
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
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DD
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YYYY
Child's Gender *
1st Parent's Name *
Your answer
1st Parent's Email Address *
Your answer
1st Parent's Primary Phone Number *
Your answer
1st Parent's Street Address *
Your answer
1st Parent's City *
Your answer
1st Parent's State *
Your answer
1st Parent's Zip Code *
Your answer
1st Parent's Employer
Your answer
1st Parent's Work Address
Your answer
1st Parent's Work Phone
Your answer
2nd Parent's Name
Your answer
2nd Parent's Email Address
Your answer
2nd Parent's Primary Phone Number
Your answer
2nd Parent's Street Address
Your answer
2nd Parent's City
Your answer
2nd Parent's State
Your answer
2nd Parent's Zip
Your answer
2nd Parent's Employer
Your answer
2nd Parent's Work Address
Your answer
2nd Parent's Work Phone Number
Your answer
Siblings - Please list siblings name, date of birth, and gender
Your answer
Family Questionnaire
Please describe the pregnancy and birth ( i.e. c-section, complications during pregnancy and birth, adoption, etc). *
Your answer
Please give a description of your home situation and daily rhythm. *
Your answer
What types of family activities do you enjoy together? *
Your answer
Please describe your child's current or past day care or school experience, if any. *
Your answer
Do you have any concerns about your child from past day care, school, or group experience? Please describe. *
Your answer
Please describe your child's strengths. *
Your answer
Please describe any aspect of your child's personality you'd like to see strengthened. *
Your answer
Please comment on your child's like and dislikes, special circumstances or experiences, fears, etc. *
Your answer
Please describe how your child plays with other children. *
Your answer
Please describe how your child plays alone. *
Your answer
What types of food does your child like to eat? *
Your answer
Screen Time and Media
How much time, on average, does your child spend on the following?
Listening to radio, records, tapes - per weekday? *
Your answer
Listening to radio, records, tapes - per weekend? *
Your answer
Watching TV, VCR/DVD, movies - per weekday? *
Your answer
Watching TV, VCR/DVD, movies - per weekend? *
Your answer
Playing computer games - per weekday? *
Your answer
Playing computer games - per weekend? *
Your answer
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. *
Your answer
Develomental Milestones
Please let us know at what age your child accomplished the following milestones.
Crawl *
Your answer
Sit Up *
Your answer
Walk *
Your answer
Grow first tooth *
Your answer
Speak first word *
Your answer
Speak in 4-5 word sentences *
Your answer
Please describe your child's development regarding the following:
Putting on shoes *
Your answer
Helping with coat *
Your answer
Pulling on pants *
Your answer
Tying a shoe *
Your answer
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.) *
Your answer
Medical History
What illnesses has your child had, particularly including measles, mumps, diphtheria, rubella, shigella, hepatitis (type?), meningitis (type?), salmonella, chicken pox, or giardia? *
Your answer
Does your child have any allergies or health issues? *
Your answer
Other
Why are you considering Waldorf education for your child? *
Your answer
Have you attended a BWK Parent Tour? *
If you have attended a tour, what was the date?
Your answer
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? *
Your answer
Anything else you would like to add?
Your answer
A copy of your responses will be emailed to the address you provided.
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