First Presbyterian Kindergarten and Preschool
Application
This information is confidential and will be used by the Director and Teachers only.
Name of child____________________________________________Sex____________
Name preferred to be used_________________________Date of Birth______________
Address_________________________________________________________________
Home Phone_________________________Cell Phone___________________________
Previous school attended____________________________________________________
Name of person other than parent to pick up child________________________________
________________________________________________________________________
Please check the class you are interested in for your child:
One-Year-Old ___Two- Year- Old ___Three- Year- Old ___
3 day ___0r 5 day___
Pre-K___ Kindergarten ___ K or Pre-K with extended day ____
T.O.T. S __________
Mother:
Name_______________________________________________________
Address_____________________________________________________
Occupation________________Place of Employment_________________
Business Phone_______________________________________________
Business Address_____________________________________________
Father:
Name_______________________________________________________
Address_____________________________________________________
Occupation________________Place of Employment_________________
Business Phone_______________________________________________
Business Address_____________________________________________
Siblings:
Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________
Name_________________________________Date of Birth___________
Others living in the home (Please give relation as well as name):____________________
Are your childs regular playmates his age?_____ Older____Younger___Same Sex_____
Does your child have a pet?________What?____________________________________
Give all the information you can on the following:
Fears_______________________________________________________
____________________________________________________________
Behavior habits (biting nails, thumb sucking, tantrums, etc.)___________
____________________________________________________________
____________________________________________________________
Areas in which your child may need special help or attention:______________________
____________________________________________________________
____________________________________________________________
Any additional information which you think would be helpful?_____________________
____________________________________________________________
____________________________________________________________
Please note: A $90 fee is due at the time of registration, along with a $55 supply fee
for 3 year old students and a $65 supply fee for 4 and 5 year old students.
Refundable through June 1.
Physical Record:
Allergies?
____________________________________________________________
____________________________________________________________
How does it manifest itself?_____________________________________
____________________________________________________________
What serious illness, if any, has your child had?_________________________________
____________________________________________________________
Name of childs physician_________________________Phone____________________
Name of family physician or second choice_____________________________________
In an emergency, whom may we call if unable to reach the parent? Must list two!!
Name____________________________________Phone____________________
Relationship_______________________________________________________
Name____________________________________Phone____________________
Relationship_______________________________________________________
Permissions
(Please check and sign)
_____Permission is given for emergency medical treatment to be obtained for my child.
_____Permission is given for my child to make local field trips during school hours.
_____Permission to have my child photographed for, but not limited to, use in
advertising, articles in the newspaper, or for preparing memory books.
Signed:________________________________
(Parent or guardian)
FOR OFFICE USE ONLY
Date of Acceptance________________________
Reg. Fee Paid________Supply Fee Paid_______
