Preschool Admission Application

Calvary Christian Preschool

1009 Elizabeth Ave., Laureldale, PA 19605 | 610 929 9606 | contactcalvary@verizon.net
Preschool Admission Application

A non-refundable $25 registration fee must accompany this form. Mail or drop off check to Calvary. Contact information above.
Date

MonthDayYear
Date
Select Desired Class

Three Year Olds (must be 3 as of Sept. 1)Four Year Olds (must be 4 as of Sept. 1)
Child's Full Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender
Birth date:

MonthDayYear
Date
Is your child toilet trained? (required to attend school)

YesNo
Name of family's church/denomination:
Names and birth dates of siblings:
Language spoken at home:
Name of kindergarten child will attend:
Has your child attended any other preschool?
How did you find out about our Preschool?

Student Contact Information
Student Name:

First NameLast Name
Student resides with:

Both ParentsMother OnlyFather OnlyJoint CustodyOther
Parent/Guardian Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number:
Please enter a valid phone number.
Work Phone Number:
Please enter a valid phone number.
Employer:
May we call you at work?
Second Parent/Guardian Name: (if applicable)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Work Phone Number:
Please enter a valid phone number.
Employer:
May we call you at work?
Other than parent(s), student may be picked up be: (List name and phone number)
Emergency Contact (In addition to parent or guardian - please add three)

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.

Emergency Form

Calvary Christian Preschool
Child's Name:

First NameLast Name
Preferred Doctor:

First NameLast Name
Doctor's Phone Number:
Please enter a valid phone number.
Preferred Hospital:
Medical Insurance:
Insurance ID Number:
Allergies?
I, blanks give my permission for the school staff to take whatever steps may be necessary to obtain emergency medical care if warranted. These steps may include: attempt to contact parent/guardian, attempt to contact a parent/guardian through a listed emergency contact, and/or attempt to contact child's physician. If we cannot contact the child's physician we will do any of the following: call another physician, call an ambulance, have the child taken to the emergency room by a staff person. Any expenses incurred will be paid by the child's family. The school will not be responsible for anything that may happen as a result of false information given at the time of enrollment.
By Signing you attest that the information you provided is correct to the best of your knowledge, and you agree to the previous statements.

Clear
Date

MonthDayYear
Date
I give permission for my child to use all play equipment and participate in all school activities.

YesNo
I give permission for my child to leave the school premises under the supervision of a staff member for neighborhood walks.

YesNo
I give permission for my child to be included in evaluations and pictures connected with the school program.

YesNo
Signature

Clear

Student Contact Information