Application Form (Get Ready for Kindergarten 2021)
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 participate in all 6 weeks of the summer program (July 5th-August 13th, 2021)? If no, please explain. *
Tuition and Fees Due Dates (non-refundable)
Tuition is a total of $650 + $100 registration fee.

Registration $100 (due at time of enrollment)
Enrollment Deposit $325 (due at time of enrollment and applied to the tuition balance)
Tuition Balance $325 (due by 7/5/2021)
Days & Hours
July 5th-August 13th, 2021
Monday, Wednesday, and Friday
8:30am-12:30pm
Do you understand that the above tuition and fees and required in order for your child to attend and they are non-refundable? *
Child's Full Name *
Your Child's Preferred Name/Nickname *
Child's Date of Birth (students must turn 5 by September 1st of this year) *
Parent/Guardian Name(s): *
Home Address *
Best Contact Number (please indicate cell/home) *
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. 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. *
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 childcare? *
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 MCPKA family, google, etc.) *
Where will your child attend kindergarten? (If not in Howard County, please identify the county.) *
What priorities do you have for your child during this program? *
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