Little Bruins Preschool Interest Form

Little Bruins Preschool Interest Form
Thank you for your interest in Little Bruins Preschool! At Little Bruins Preschool, we believe in nurturing the whole child! Rooted in Christian values, our curriculum fosters academic, social, emotional and spiritual development. By completing and signing this application, you acknowledge and support your child in receiving a faith-based, integrated curriculum.*

MonthDayYear
Date
Please check if applicable:

I am an employee of Belmont UniversityI am a student of Belmont UniversityI am affiliated with The StoreI am an alumni of Belmont University
If an employee or student, what is your BUID?
Email address of person filling out this form:
example@example.com
Student Information
Name (Fill out a new application for each child.)

First Name(Preferred Name)Last Name
Primary Language Spoken at Home
School Last Attended
Gender
Date of Birth

MonthDayYear
Date
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first*
Status of Parents/Guardians
If separated, divorced or other, please describe the current legal Custody Order arrangement. Please note that if accepted into Little Bruins Preschool, a copy of the current Custody Order will need to be provided prior to enrolling.
Programs

Please indicate your programming needs

Rows	Academic Day (9:00-3:30)	Before Care (7:30-9:00)	After Care (3:30-5:30)
ACADEMIC YEAR (August 4, 2025 - May 22, 2026)

Preferred Start Date

MonthDayYear
Date
Summer Program: Our Little Bruins Preschool Summer Program will run from June 1, 2026-July 24, 2026 (with the exception of June 19 and July 3). Please indicate your interest below.

YesNo
Please list and describe (including dates of service), all services your child has previously had or is currently receiving.
Please provide the names, addresses and dates of service for all schools or early childhood programs your child has attended.
Please note that if accepted into Little Bruins Preschool, a Teacher Evaluation from your child's previous teacher will be needed prior to enrolling.
Please describe your child including strengths and areas that are challenging. What goals do you have for your child?
Mission and Vision Statements
How did you hear about us?

Internet searchSocial mediaBelmont websiteCommunity eventLocal newspaper/magazineEmail advertisementLocal parent groupDrove by locationWord of mouth/referralOther
If referred, who can we thank?
Name
Should be Empty:

Student Information