2024 - 2025 Preschool Application
Child Name
*
First Name
Last Name
Birthdate
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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2009
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1928
1927
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1925
1924
1923
1922
1921
1920
Year
Child's Gender
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Home/Work Phone:
*
Please enter a valid phone number.
Parent Guardian Cell Phone:
*
Please enter a valid phone number.
Relationship to the child
*
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Home/Work Phone:
Please enter a valid phone number.
Parent/Guardian Cell Phone
Please enter a valid phone number.
Relationship to the child
Parent/Guardian Martial Status
*
Custodial/ Visitation Arrangements:
Emergency Contact
*
First Name
Last Name
Relationship to child:
Phone Number
*
Please enter a valid phone number.
Who lives in the household?
*
Names and ages of other children in the family and school’s attending?
*
What languages are spoken in the home?
*
Describe any previous preschool/daycare experiences.
*
What are your child's interests?
*
In order for our teachers to best meet your child’s education needs, please describe any conditions which affect how your child learns?
*
Does your child have any difficulty seeing, hearing, walking or speaking?
*
Parent/Guardians’ evaluation of child’s health:
*
Does your child have allergies or dietary needs?
*
Does your child take prescription medication for any physical, emotional, or behavioral issues? If so, please describe:
*
Are there any other health issues we should be aware of?
*
Pediatrician
*
Dentist
*
If your child is accepted, additional paperwork and deposit must be submitted to KiDiMu within 15 days. Please initial.
*
Submit
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