Enrollment Application - Little Scholars Academy

Which facility are you interested in?*

Johns Landing Preschool
SW PDX Pre-K

Requested Starting Date*

Days Needed?

How did you hear about us?

Child’s Name*

Child's Birthdate*

Home Address*

Street Address Address Line 2 City ZIP / Postal Code

Phone

Parent Information

Parent's Name*

Parent's Cell Phone*

Parent's Email*

Parent's Employer*

Parent's Profession*

Parent's Position*

Second Parent's Name*

Second Parent's Cell Phone*

Second Parent's Email*

Second Parent's Profession*

Second Parent's Employer*

Second Parent's Position*

Child Information

Is this your

First Child
Second Child
Third 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?

Yes
No

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?

Yes
No

If no, why are you making a change?

What are your expectations of your teachers?

Request for Enrollment

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. (There is no fee to submit this application for the wait-list.) TEMPORARY CARE for ESSENTIAL PERSONNEL: If you are an essential worker applying for temporary child care during the COVID-19 crisis you will be offered a reduced rate on a weekly basis, not be subject to an in-person interview, and no deposit will be required. Details will be provided upon receipt of your application.

Parent Signature*

Parent 2 Signature*