SonShine
Kids Preschool Application 2011-2012
(Do NOT press the "Enter" or "Return" Keys while entering information)
Child’s
Full Name
Nickname
Date of
Birth
Age
Gender
Address
(Street/apt. #)
(City/state/zip)
Mailing
address (if different than above)
Address
(Street/apt. #)
(City/state/zip)
Home Phone
Email Address
Mother’s
Cell Phone
Father’s Cell Phone
Place of
Employment
Father
Work Phone
Mother
Work Phone
Has your
child attended preschool before?
Yes:
No:
If yes, Where?
Do you
attend church?
Yes:
No: Where?
Tuition :
2 days per
week: $85/month $20 Supply fee per semester
3 days per week: $100/month $30 Supply fee per
semester
5 days per
week: $130/month $40 Supply fee per semester
Please
Indicate Your Choice:
(Please choose one)
Tuesday/Thursday 9:00 AM-12:00 PM
Monday, Wednesday, Friday 9:00 AM-12:00 PM
Monday-Friday 9:00-12:00 PM
Medical
History
Full Name DOB(MM/DD/YYYY) SS#
Was child
full term? YES: NO: Birth
weight
Lbs
Oz
Pediatrician’s Name ¬ Address ¬
Phone ¬
Hospital
of Preference
Emergency
Contact #1
Phone
Cell
Emergency
Contact #2
Phone
Cell
Any
surgeries? YES: NO: If yes,
please explain
Any
serious illnesses? YES:
NO:
If yes,
please explain
Allergies
to food or medications? YES:
NO:
If
yes, please explain which
Allergies
to bees? YES: NO:
Any
illness such as asthma or epilepsy that would involve extra attention during
playtime?
Does your
child need an inhaler or an EpiPen? YES:
NO: (If yes, a written
order from the doctor must be obtained)
Media
Release
We will be
taking pictures on a regular basis. There may be times when we would like to
use your child’s picture on our website or in the local paper, or just
posted in our hallways.
I,
, give SonShine Kids Preschool
permission to take photographs of my child,
, and use them on their website for
promotional purposes, in the local newspaper, or for use within the school.
OR
I,
, do not give
SonsShine Kids Preschool permission to take photographs of my child,
, and use them on their website for
promotional purposes, in the local newspaper, or for use within the school.
Child
Questionnaire
Does your
child play well with other children?
YES:
NO:
Please
list name and age of all siblings.
Does your
child know any colors?
YES: NO:
If yes,
please list
Does your
child know any letters or numbers?
YES: NO:
If yes,
please list
Can your
child recognize their name when written?
YES:
NO:
Does your
child know how to write his/her First Name?
YES:
NO:
Last
Name? YES:
NO:
Do you
have any concerns about your child or any information that will help us to
better understand your child?
YES:
NO:
If yes, please
explain:
Transportation
It is
very important that we have current information regarding color and model of
all vehicles that may transport your child. We will not release your child
to any person or vehicle not listed on your transportation form. There will
be more information in our handbook explaining our drop-off/pick-up
procedure.
Who
will be primarily transporting your child to school?
drives
a
Name Relationship Color
Model
Others who may transport your child:
drives
a
Name
Relationship Color
Model
drives
a
Name
Relationship Color
Model
drives
a
Name
Relationship Color
Model