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
Students 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?
What do you hope a preschool experience at the Little Village will offer your child?
How did you hear about the Little Village at the New Village School?
Should be Empty:

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

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