Preschool Application

Preschool Admissions Application
Please attach a picture of your child here *

Cancelof
Applying for School Year*
Grade Entering*
Student's Full Name*

First NameMiddle NameLast Name
Student's Nickname (Optional)*
Student's Date of Birth*

MonthDayYear
Date
Student's Gender*

FemaleMalePrefer not to sayOther
Student's Birthplace*
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your child enrolled in any childcare or preschool programs?*

YesNo
Current School Information
Name of Current School *
Telephone of Current School*
Please enter a valid phone number.
Address of Current School*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Information
(1) Name of Parent/Guardian A*

First NameLast Name
Relationship to Student*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation and Employer*
(1) Name of Parent/Guardian B*

First NameLast Name
Relationship to Student*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation and Employer*
Parent(s)/Guardian(s) is/are:*
Please explain if the child does not live with both biological or adopted parents in one household. With whom does the child live and who has primary legal custody?*
Children in the Family
Other than student applying - please ignore if not applicable
Select number of children*
1st child Name*

First NameLast Name
1st Child Date of Birth*

MonthDayYear
Date
1st Child Current School*
1st Child Current Grade*
Relationship to Applying Student 1*
2nd Child Name*

First NameLast Name
2nd Child Date of Birth*

MonthDayYear
Date
2nd Child Current School*
2nd Child Current Grade*
Relationship to Applying Student 2*
Child’s grandparent(s) and other family members who may wish to
attend school events
Select number of family members*
Family Member's Full Name 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to student*
Family Member's Full Name 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to student*
Medical
Are there any health-related issues such as allergies or other health problems which we should be aware? Is your child presently under medical treatment? If yes, please explain:*

YesNo
Has your child received any evaluations or treatments? (e.g. speech therapy, occupational therapy) If yes, please explain:*

YesNo
Has your child’s hearing and/or vision been tested? Results? Does your child wear glasses? If yes, please explain:*

YesNo
Has your child had ear infections (approximate age)? Tubes? If yes, please explain:*

YesNo
Has your child had any surgeries or serious injuries? If yes, please explain:*

YesNo
Does your child have allergies? If yes, please explain:*

YesNo
Has your child experienced seizures? If yes, please explain:*

YesNo
Does your child use medication? If yes, please explain:*

YesNo
Has your child had childhood diseases or major illnesses? If yes, please explain:*

YesNo
Infancy and Early Childhood
Is there anything about your child’s birth or infancy that would be helpful for us to know?*
How is your child’s diet? Has your child had any difficulty with feeding? Please describe: *
How is your child’s sleep? Does your child nap?*
What part of dressing can your child do independently? *
Developmental Milestones

Please share the approximate age your child did the following:
Sat unassisted: *
Crawled: *
Walked:*
Toilet trained:*
Babbled: *
Said first words: *
Said 1-2 word phrases:*
Said sentences: *
Ate solid foods:*
Speech and Language History
Please provide a few examples of your child’s present speech and language skills and their ability to follow directions. *
Is your child exposed to more than one language? *
Your child….
What character traits stand out most in your child? *
What activities, if any, does your child participate in outside of the home? *
What chores does your child help with at home? *
What relationship does your child have and family have with screentime? *
What interests your child in play?*
Please describe anything else that you feel would contribute to creating a picture of your child and would best help us meet their needs. *
Parent/Guardian Questions
How do you support your child’s growth?*
In what ways do you believe your child will benefit from the educational journey offered at the New Village School? *
How did you hear about the Little Village at the New Village School? *
What is the main attraction of the New Village School for your child and your family?*
Financial Information
Person responsible for all fees*
Relationship to student*
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Application Fee
Application fee*

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Preschool Admissions Application

Child’s grandparent(s) and other family members who may wish toattend school events

Medical

Infancy and Early Childhood

Developmental Milestones

Speech and Language History

Your child….

Parent/Guardian Questions

Financial Information

Child’s grandparent(s) and other family members who may wish to
attend school events