Early Learning Program Admitted Student Information 2026-27

Admitted Student Information

2026 - 27
Student Information
Child's Name

First NameMiddle NameLast Name
Nickname
Gender
Birth Date

MonthDayYear
Primary Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone
Format: (000) 000-0000.
Primary E-mail Address
example@example.com
Subdivision
Zoned Public School District
ELP Enrollment Date (First Month and Year Attended ELP)
Family Information
Guardian's Name

First NameLast Name
Relationship
Church Membership
E-mail Address
example@example.com
Phone
Format: (000) 000-0000.
Occupation
Place of Employment
Guardian's Name

First NameLast Name
Relationship
Church Membership
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Place of Employment
Parents Marital Staus
If divorced or separated, who has custody?
Siblings Living at Home
Name
Age
Name
Age
Name
Age
Name
Age
Schools Siblings Currently Attend

Additional Persons to Be Contacted in Case of Emergency and Authorized to Pick Up Child

Please complete all sections fully for each contact listed. We require a full name, address, phone number, and relationship for every contact.For safety reasons, children must be signed in and left in the care of a staff member upon arrival. Children will be released only to parents/guardians or to adults specifically authorized in writing by a parent/guardian. A staff member must be notified of and present for a child’s departure.Please list all individuals you authorize to pick up your child and those who may be contacted in the event of an emergency if a parent/guardian cannot be reached. Be sure that everyone you list is willing and able to pick up your child in the case of illness or emergency.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship

Medical Information and Emergency Medical Authorization
In the event that I cannot be reached to make arrangements for emergency medical authorization, I authorize the facility director or staff person in charge to take my child to:
Physician's Name
Physician's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Physician's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Hospital
Insurance Company
Insurance Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Policy Number
Known Allergies
If none, write "none". All Food Allergies require a FARE form (Food Allergy & Anaphylaxis Emergency Care Plan) to be filled out and signed by a physician. If EPI Pen is prescribed, one must be provided to be kept at ELP.
Reaction
Plan of Action
Known Food Sensitivities
If none, write "none".
Reaction
Plan of Action
Medicine Regularly Taken
Medication may never be transported in or stored in backpacks. ELP does not routinely administer medication and will only store and administer emergency medication that is provided by the parent, along with all required information and documentation.
I give my consent for necessary emergency treatment when my child is in the care of this physician and/or hospital.

Introductory Information

This information is for the CONFIDENTIAL use of the teachers and staff who will be working with your child. Please help us get to know a little about your child.
Other Preschools or Programs Previously Attended
Other Programs Concurrently Attending (therapy, dance, music, etc)
Other Adults Living in Home
Does the child have any pets? What are they?
Child's Favorite Toys
Who cares for child when parents are away?
Child's Favorite Activities
Does your child like stories and books? Do they have a favorite?
Does your child like music? Do they have a favorite song or artist?
What activities does the family enjoy doing together?
Who does your child play with when not at school?
Does your child enjoy mealtimes? Do they sit in a highchair or booster seat with a seatbelt?
If your child is currently in a highchair or booster at home, we recommend practicing sitting at a small table with their lunch kit to better bridge home and school.
Primary Language Spoken at Home
What is your child's typical speech?
Does you child feed themselves?
How many hours at night does your child typically sleep?
Typical Bedtime

Hour Minutes

AM/PM Option
Typical Awake Time

Hour Minutes

AM/PM Option
Does your child nap? How long?
Does your child share a bedroom?
Does your child dress and undress themselves?
Stages of Bathroom Independence
What words does your child use for bathroom/toileting functions?
Does your child have specific fears or stressors?
How would you describe your child’s temperament at home?
What helps your child feel calm, safe, and understood when they’re upset?
How do you typically guide or redirect your child when they’re having a hard moment?
Are there any approaches that don’t work well or that your child finds upsetting?
Are there any behaviors or concerns you would like to bring to our attention, such as thumb sucking, pacifier use, jealousy, frequent crying, or seeking extra attention?
We want to be as consistent and supportive as possible. Is there anything about your child’s temperament or emotional needs that would help us support them well at school? Are there recent or current stressors (divorce, separation, loss)?
What are your hopes and aspirations for your child both for this year and for life?
We are looking forward to getting to know your child this year! Is there anything else you would like us to know about your child?

Developmental History

Age of Milestones
Crawled
Sat Alone
Walked
Named Simple Objects
Began Using 2-3 Word Phrases
Beagn Toilet Training
Completed Toilet Training
All students in the 3 day PK - 3's, the PK-4's, and TK must be fully toilet trained. (undress, wipe, dress, wash hands - no pull ups) Please see the office for more information.
Health History
Does your child have frequent colds?
Does your child have a history of ear infections?
Does your child run a high fever easily?
Has your child ever had a seizure?
Has your child had a serious illness?
Has your child had a serious accident?
Has your child been hospitalized in the past 12 months?
Were their difficulties at birth?
Was your child more than 3 weeks premature?
Has your child visited a dentist?
Do they have a dental appliance?
Has your child had their vision tested?
Do they wear glasses or other vision appliances?
Do you suspect any vision, hearing, or language difficulties? If so, please elaborate.
Is your child receiving ongoing care from a specialist? If so, please elaborate.
Please include where the child is receiving services. If none, enter "none".
Is your child receiving any other therapy services? If so, please elaborate.
Please include where the child is receiving services. If none, enter "none".
Please tell us about any other concerns or needs.

Additional Required Information

This form, along with all required medical documentation, must be submitted at least two weeks prior to your child’s start date. You may download and print the form, have it completed by your child’s physician, and return it to the office by printing, emailing, or uploading it here. Alternatively, you may upload all medical documents provided by the physician’s office.
Documents Required
- Child's Health Statement: A signed statement from a physician or health-care professional verifying the child has been examined within the past year and is able to participate in preschool.
- Immunization Records: An up-to-date, validated record of all required vaccinations or notarized affidavit for exemption.
- Vision and hearing screening results (for children ages 4 by September 1 and older). ELP will host vision, speech, and hearing screeings in the fall. This service is free for first time students and for a small fee for returning students.
All documents must be signed and dated.
Medical Information
Immunization Status - ELP is required to maintain accurate immunization records for all students. More information may be accessed at https://www.dshs.texas.gov/immunizations.
File Upload

Cancelof
I certify that I am the legal guardian and that the information provided is accurate and complete. I understand the importance of notifying the ELP office of any changes or updates, as failure to do so may result in dismissal.
Name

First NameLast Name
Date Signed

MonthDayYear
Date
Should be Empty:

Rows	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness

Admitted Student Information

Student Information

Family Information

Siblings Living at Home

Additional Persons to Be Contacted in Case of Emergency and Authorized to Pick Up Child

Medical Information and Emergency Medical Authorization

Introductory Information

Developmental History

Health History

Additional Authorizations and Information

Heading

Additional Required Information