Online Application
Email address *
Child's Name (First, Middle, & Last) *
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Male or Female *
Date of Birth *
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DD
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YYYY
Birthplace *
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Address *
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Primary Phone # *
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Primary Email *
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Parent/Responsible Party info
Father's Name *
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Employer *
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Work Phone # *
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Address (if different)
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Cell Phone number
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Church
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Mother's Name *
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Employer
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Work number
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Address (if different)
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Cell number
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Church
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CHOOSE THE DAYS YOU ARE APPLYING FOR: Note-August 31 of school year is the birthdate cutoff for each age group *****Classes are subject to change based on enrollment. Check the days you prefer, we will make every effort to accommodate your preferences. All classes are filled on a first come first served basis. There are no guarantees. *
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Please list others in the home sibling/ages
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Adults in the home other than parents
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Pets/names
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What other information should we know/be aware of to care for your child as an individual? Events at home often influence your child's behavior. We are better able to help your child when you inform us of situations and/or events that might influence his/her overall behavior such as: Divorce, Separation from a relative or friend, Death of a relative or friend. Knowing about these transitional times allows us to give special attention, understanding, and care. The information you give us will remain confidential. Has anything happened recently in your child’s life that might have an effect on her/him? Are there any unusual fears or special traits that the teacher may need to know about:
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Please list any allergies your child may have, his/her reaction to exposure, and procedure to follow in the event of exposure:
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List any health problems/medical diagnosis that would restrict your child’s school activities:
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child’s doctor/phone #
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child’s dentist/phone #
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EMERGENCY CONTACT WHEN PARENTS CAN’T BE REACHED: (NAME, RELATIONSHIP, PHONE NUMBER)
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IN THE EVENT THAT IMMEDIATE MEDICAL TREATMENT IS REQUIRED FOR MY CHILD, AND I CAN NOT BE REACHED, ARDEN PRESBYTERIAN PRESCHOOL & KINDERGARTEN MAY TRANSPORT MY CHILD BY ANY MEANS NECESSARY TO AN APPROPRIATE MEDICAL FACILITY FOR CARE. We are committed to the personal safety of each child entrusted to our care. Therefore, according to preschool policy, admission will normally not be granted to any prospective student who has an immediate family member who is listed on the National Registry of Sexual Offenders. See preschool policy for more details. Photography Release Information: Photographs are occasionally made by the staff to be used for programs, promotional and educational purposes. Unless specific written permission is obtained from the parent or legal guardian, children’s names will never be used nor is any other confidential information shared. I give my permission for my child to be included in photographs taken at Arden Presbyterian Preschool & Kindergarten. Type your name below to serve as an electronic signature
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