2025-26 APPLICATION FORM

2025-2026 APPLICATION FORM
**A separate application form and contract are required for each child you are enrolling**
ENROLLMENT DETAILS*

CURRENT STUDENT RE-ENROLLINGNEW STUDENT APPLYING
Non-Refundable $400 Enrollment Fee

PLEASE NOTE: This fee no longer applies towards tuition
Bill my FACTS Account*

I understand that with the submission of this application, my FACTS account will be charged $400 within the next 48 hours.
I understand that with the submission of this application, my FACTS account will be charged $400 within the next 48 hours.
Requires $150 Application Fee & Non-Refundable $400 Enrollment Fee - PLEASE NOTE: These fees do not apply toward tuition*

On-line Payment ($10 convenience fee will be added)Cash or Check (can be dropped off at the school office or mailed to: 5100 Camden Ave, San Jose, CA 95124. Please make checks payable to St. Timothy's)Bill my FACTS Account (current families only) will be charged within the next 48 hours from submitting this application
I understand that a $550 deposit must be submitted WITH this application (if paying by cash or check, payment must be received within 1 business day of submitted application).
PROGRAM SELECTION

(Students entering 3's class and above must be fully potty trained)
PROGRAM*

2's Class3's ClassJr. Kindergarten
LIMITED SPOTS REMAINING

DO NOT SUBMIT ANY PAYMENT BEFORE

CONTACTING OUR OFFICE AT 408-265-0244

TO SECURE YOUR CHILD'S SPOT

PLEASE PROCEED TO FILL OUT APPLICATION
SPECIFY DESIRED DAYS*

TUE. & THU.MON. / WED. / FRI.MONDAY - FRIDAY
SPECIFY DESIRED DAYS*

MON. / WED. / FRI.MONDAY - FRIDAY
SPECIFY DESIRED SCHEDULE*

HALF DAY (8:45 am - 12:00 pm)FULL DAY (8:45 am - 3:00 pm)EXTENDED CARE (7:15 am - 6:00 pm)
STUDENT INFORMATION
Child's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birthdate*

MonthDayYear
Date
Gender*

MaleFemale
Child lives with:*

Both ParentsMother OnlyFather OnlyOther (Grandfather, Aunt, etc.)
Primary Language Spoken at Home:*
English, Spanish, Chinese, etc.
Ethnicity

Hispanic/LatinoNon-Hispanic/Non-Latino
Race/Ethnicity

African-American/BlackAmerican Indian/Alaska NativeAsianNative Hawaiian/Other Pacific IslanderCaucasian/WhiteOther
FAMILY INFORMATION
Parent/Guardian #1*

First NameLast Name
Relationship*

MotherFatherOther (Grandfather, Aunt, etc.)
Address (if different from above)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Parent/Guardian #2*

First NameLast Name
Relationship*

MotherFatherOther (Grandfather, Aunt, etc.)
Address (if different from above)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Sibling(s)*

YesNo
Name
Age
Current student at St. Timothy's Christian Preschool
Name
Age
Current student at St. Timothy's Christian Preschool
Name
Age
Current student at St. Timothy's Christian Preschool
Allergy / Medical Information
My child has an allergy/medical condition*

YesNo
Please specify the allergy or medical condition
Preferred Hospital in case of an Emergency*
PEOPLE AUTHORIZED TO PICK UP MY CHILD

We need at least ONE person other than the parents to be listed as an emergency contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
(Grandfather, Aunt, Friend, etc.)
Emergency Contact when parent/guardian cannot be reached
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
(Grandfather, Aunt, Friend, etc.)
Emergency Contact when parent/guardian cannot be reached
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
(Grandfather, Aunt, Friend, etc.)
Emergency Contact when parent/guardian cannot be reached
Permission Statements
I hereby give permission for my child to be photographed and/or video taped at St. Timothy's Christian Preschool or on a school trip. I understand that these pictures could be used in school projects, newsletters, social media, brochures, and/or possible advertising.*

ALL OKNO SOCIAL MEDIA OR MARKETINGNONE PERMITTED
I give permission to have my name, address, phone number and email in the school directory*

YESNO
Parent Signature*

Clear
Student Survey
My child is an active member of St. Timothy's Lutheran Church*

YESNO
Digital Signature
We, as parents, understand that quality education requires the joint effort of home and school. As a result, we will be supportive of the programs and policies of the school in order to strengthen our child's Christian education.*

Acknowledge
An authorized representative or licensing analyst from the Department of Social Services/Community Care Licensing may, upon presentation of proper identification, enter and inspect the preschool at any time with or without prior notice. The DSS/CCL has the authority to interview children and staff without prior consent.*

Acknowledge
Parent Name*

First NameLast Name
Date

MonthDayYear
Date
Parent Signature*

Clear
***PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS***
Should be Empty:

2025-2026 APPLICATION FORM

**A separate application form and contract are required for each child you are enrolling**

Non-Refundable $400 Enrollment Fee

PROGRAM SELECTION

LIMITED SPOTS REMAINING

DO NOT SUBMIT ANY PAYMENT BEFORE

CONTACTING OUR OFFICE AT 408-265-0244

TO SECURE YOUR CHILD'S SPOT

PLEASE PROCEED TO FILL OUT APPLICATION

STUDENT INFORMATION

FAMILY INFORMATION

Allergy / Medical Information

PEOPLE AUTHORIZED TO PICK UP MY CHILD

Permission Statements

Student Survey

Digital Signature

***PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS***

A separate application form and contract are required for each child you are enrolling

PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS