Enrollment Application Which facility are you interested in?*Johns Landing PreschoolSW PDX Pre-KRequested Starting Date* Date Format: MM slash DD slash YYYY Days Needed? Monday Tuesday Wednesday Thursday FridayHow did you hear about us?Child’s Name*Child's Birthdate*Home Address* Street Address Address Line 2 City ZIP / Postal Code Phone Parent InformationParent'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 InformationIs this yourFirst ChildSecond ChildThird ChildDo 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?YesNoAre 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?YesNoIf 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.)Parent Signature*Parent 2 Signature*
