Peer Program Enrollment

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This form is to be completed to show interest in the preschool program for the 2025/2026 school year.

By completing this form, you are expressing an interest in having your son/daughter participate in the Big Walnut Preschool Program as a Peer Model. The Big Walnut Preschool Program is a special needs preschool geared at strengthening the skills of students with disabilities with an added benefit of preparing all students for kindergarten.

The peer program is designed for students who are 4 years old prior to August 1st with the intention of registering for kindergarten the following school year. Peers serve as models of age-appropriate skills for children demonstrating delays in their development.

You will be contacted within 5 business days to determine next steps and if a peer spot is available.

**If you have concerns about your child's development, your child's behavior, or if a teacher, therapist, or medical professional has expressed concerns about your child, DO NOT complete this enrollment request form. Instead, email jessicashelton@bwls.net to share your concerns to see how we can best support your child's needs.**

Email *

Child's Name *

Child's Birthdate *

YYYY

Parent name and phone number *

Parent email address to send verification *

Based on your address, what is your home elementary building. If you are unsure, see the link of our district map here. *

Big Walnut Elementary (BWE)

General Rosecrans Elementary (GRE)

Prairie Run Elementary (PRE)

Hylen Souders Elementary (SOU)

If the district is able to provide transportation to peers, please list the address the student resides or will be transported to/from (note we do not transport from day cares, only residences--this can include a in home day-care provider). If it is two different addresses please indicate TO and FROM within this section.

***Please mark N/A if you are going to drive your child and proceed to the next question.

If your child is a car rider you will need to sign a document stating you will be transporting the entire year including pick up and drop off. Please mark that you agree.
*

Yes

If the district is transporting peers, my student will ride the bus.

Their is a cost for our 4-day peer model program. The cost of preschool tuition is $225.
*

Yes, I agree to pay the monthly tuition fee by the 1st of the month. To hold a spot in the program we require the last month tuition at time of registration.

I would like information about free/reduced tuition based on household income.

Other:

Is your child completely toilet trained? (wears underwear and not pull-ups, verbalizes to adult when they need to use the restroom, able to wipe after bowel movement independently, has not had an "accident" in the past 2 months)
*

Yes

Other:

Does your child separate easily from parent/main caregiver?
*

Yes

Other:

Does your child speak in clear sentences? Is your child's speech clear and understandable by unfamiliar adults?
*

Yes

Other:

Does your child talk to other children while playing?
*

Yes

Other:

Does your child demonstrate an ability to use crayons, scissors and glue to complete a project?

Yes

Other:

Clear selection

Is your child well-coordinated and able to walk, run, jump and climb?
*

Yes

Other:

THANK YOU!

Thank you for filling out this form to indicate your interest in the preschool program for the 2025/2026 school year. You will be contacted within 5 business days to determine next steps and if a peer spot is available.

A copy of your responses will be emailed to the address you provided.

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