2025 - 2026 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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5
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1931
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1929
1928
1927
1926
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 how your child best learns?
*
Does your child have any difficulty seeing, hearing, walking or communicating?
*
Parent/Guardians’ evaluation of child’s health:
*
Does your child have allergies or dietary needs?
*
Does your child take prescription medication?
*
Are there any other health concerns we should be aware of?
*
Pediatrician
*
Dentist
*
Please share any additional information that you think might be helpful to our preschool staff.
If your child is accepted, additional paperwork and deposit must be submitted to KiDiMu within 15 days. Please initial.
*
Submit
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