Enrollment Application

Which facility are you interested in?

Johns LandingSW PDX


Requested Starting Date :


Days Needed?

MondayTuesdayWednesdayThursdayFriday


How did you hear about us?


Child’s Name


Birth Date


Home Address


City Zip


Phone





Parent's Name


Cell


Email


Employer


Profession


Position


How Long?





Parent's Name


Cell


Email


Employer


Profession


Position


How Long?





Is this your : First ChildSecond ChildThird Child


Do any physical limitations, special requirements or allergies exist that we should be aware of to better care for your child?


Do you have any religious/spiritual/other beliefs that would require our attention?


Is your child a vegetarian? YesNo


Are there any foods your child does not like?


What hours will you normally need?


Tell us about your child’s current daily nap schedule.


Is this your first experience with preschool? YesNo


If no, why are you making a change?


What are your expectations of your teachers?


We would like our child to be considered for enrollment at Little Scholars Academy. We understand the rates, hours, holiday/vacation schedule and that an in-person interview, with both of us and our child, is part of the enrollment process. We also understand that a deposit, equal to one month’s fees, will be required upon enrollment. Note: There is no fee to submit this application for the wait-list.


Parent Signature:


Parent Signature: