John Knox Preschool

Application for Admission

Application for Admission
Child's Name
First Middle Last
Gender
- Male
- Female
Age
Date of Birth
Date Format: MM slash DD slash YYYY
Home Address
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Program Schedule
SCHOOL YEAR*
- 2024-25
- 2023-24
SCHOOL YEAR
Please choose the program:
- 3 YEAR OLD CLASS, Thursday, Friday 9:00-11:30
- 4/5 YEAR OLD CLASS Extended Day - Monday, Tuesday, Wednesday 9:00-12:15pm
Parent/Guardian #1
Parent/Guardian’s Name
First Last
Phone
Email Address
Business/Cell Phone
Occupation
Place of Business
Business Address
Parent/Guardian #2
Parent/Guardian’s Name
First Last
Phone
Email Address
Business/Cell Phone
Occupation
Place of Business
Business Address
In the event of an emergency, if the parents cannot be reached, please contact:
Emergency Contact
Name Address Phone Relationship

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Do both parents now live with the child?
- Yes
- No
If not, which parent has custody?
List names and dates of birth (DOB) of other children in the family:
Name DOB

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Are you a member of John Knox Church?
- Yes
- No
Have you ever had a child enrolled at John Knox Preschool?
- Yes
- No
Name
Year enrolled
How did you learn about John Knox Preschool?
By what name is the child called at home?
What does your child like to do or play with at home?
Is there anything that you would like us to know about your child that would help us to understand him/her better?
What would you particularly like us to help you with concerning your child?
PARENT ROSTER STATEMENT

In accordance with rule 5101: 2 12 32 of the Administrative Code, a roster for each group of children, which includes names and telephone numbers of parents, custodians, or guardians of children attending the center must be prepared annually and given to parents, custodians, or guardians upon request. Class lists are distributed to each parent to help families become acquainted.
NO OUTSIDE USES OF THIS INFORMATION ARE APPROVED.
- I WOULD like my name and telephone number to be included in this roster.
- I WOULD NOT like my name and telephone number to be included in this roster.
Registration fee
Price: $75.00
Signature
Date
Date Format: MM slash DD slash YYYY

Please note that all information provided on this form will be kept confidential.

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Name	Address	Phone	Relationship

Name	DOB

John Knox Preschool

Application for Admission

Program Schedule

Parent/Guardian #1

Parent/Guardian #2

In the event of an emergency, if the parents cannot be reached, please contact:

PARENT ROSTER STATEMENT

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