First Presbyterian Preschool Application

First Presbyterian Preschool Application
Student Information
Child's Name *

First NameLast Name
Preferred Name *
Child's Birthday*

MonthDayYear
Date
Gender*
Does your child have any allergies? If so, please explain*
Please list any previous preschool experience:
Has this child ever been referred for testing of any kind or participated in therapy? If so, please explain:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
With who does this child reside?*
Who has custodial rights of this child?*
Parent Information
Parent 1*

First NameLast Name
Parent 1 Phone Number*
Please enter a valid phone number.
Parent 1 Email *
example@example.com
Occupation
Employer
Parent 2*

First NameLast Name
Parent 2 Phone Number*
Please enter a valid phone number.
Parent 2 Email*
example@example.com
Occupation
Employer
Additional Information
Are you First Presbyterian Church Members*
If so, have you been members for 6 months prior to application?
Enrollment
Please select the appropriate age level and number of days:*
Please select your second choice for class placement*
School year for which you are applying
I understand that to finalize this application I must also submit a non-refundable application fee of $140. (Sign in the box below)*

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My Products*

Application Fee

$140.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Student Information