Enrollment Application

APPLICATION INSTRUCTIONS

THANK YOU FOR YOUR INTEREST IN TRINITY EPISCOPAL PRESCHOOL!

PreK 3’s & 4 applicants must be completely toilet trained, and all children must be the appropriate age of class planning to enroll in on or before September 1st.

To Begin the Enrollment Process, Please Submit the Following:

• Application for Enrollment Completed and Signed

• Non-Refundable Enrollment Fee: $100.00/ per student

• Copy of Birth Certificate

Before your child starts school, you will need to provide the school with the following:

• NOTORIZED Medical Release Form

• Your child’s current PHYSICAL form

• Your child’s up to date IMMUNIZATION record

• SIGNED FORM acknowledging read INFLUENZA/misc. pamphlets and handbook.

Trinity Episcopal Preschool

Enrollment Application 2020-2021

Preschool Enrollment Application 2020-2021

Child's Name *

First & Last

Birth Date *

MM/DD/YYYY

Present Age *

Gender *

Male

Female

Child's Nickname *

If applicable

Primary Language *

Child's Ethnicity *

Trinity Episcopal Preschool does not discriminate based on race, color national or ethnic origin.

Legal Custody *

Both Parents

Mother

Father

Other Relation

Person(s) Child Lives With *

Custody/Visiting Arrangements *

Copy of Custody/Legal Papers must be on file at school

Father/Guardian Info *

Father

Stepfather

Guardian

Name *

Home Address *

City *

Zip *

Occupation *

Employer *

Home Phone *

Cell Phone *

Work Phone *

Email *

Mother/Guardian Info *

Mother

Stepmother

Guardian

Name *

Home Address *

City *

Zip *

Occupation *

Employer *

Home Phone *

Cell Phone *

Work Phone *

Email *

APPLICATION INSTRUCTIONS - Select Applicable Program Below *

2-Year-Old Program

PreK 3

PreK 4

Before Care

7:30am-8:30am

Schedule *

9:00am-12:00pm

9:00am-3:00pm

9:00am-5:30pm

PERSONAL INFORMATION - Has your child previously attended preschool or daycare? *

If yes, where? *

Do you have any concerns regarding your child's development? *

(Speech, motor, social or behavioral etc.)

What three (3) words best describe your child? *

Sibling's Name

Age

Sibling's Name

Age

Sibling's Name

Age

Sibling's Name

Age

Does your child have special dietary requirements? *

Please list any known allergies *

Does your child have any special fears? *

What are your expectations for your child’s general behavior, and how are deviations from this behavior handled at home? *

How does your child respond to authority? *

Please list any religious training your child has received (Sunday school, family devotions, etc.). *

What, if any, is your Religious Affiliation? *

Do you currently have a church home? *

Yes

If yes, what is the name of your church?

Would you like to receive information about Trinity Episcopal Church? *

Yes

MEDICAL INFORMATION - Student Name *

First & Last

Birth Date *

MM/DD/YYYY

Gender *

Male

Female

Home Address *

City *

Zip *

Father (or Guardian) *

Email *

Cell Phone *

Mother (or Guardian) *

Email *

Cell Phone *

Backup Emergency Contact *

Email *

Cell Phone *

Relationship to Student *

Dentist *

Phone *

Date of Last DPT or Tetanus *

Are your Child's immunizations up to date? *

Yes

Additional medical information we should know about your child *

Does your child take any medication(s) regularly? *

Yes

If yes, please list medications

Child's Physician *

Physician's Phone *

Health Plan *

Group# *

ID# *

I, parent/guardian of a student of Trinity Episcopal Preschool, do hereby grant Trinity Episcopal Preschool, in the event of an emergency situation with the above named child which requires immediate attention, my permission and authority to take all necessary measures, including but not limited to: administration of first aid treatment and/or transport to a medical facility, for the necessary and appropriate treatment of *

I hereby release Trinity Episcopal Preschool of and from all financial responsibility incurred with respect to medical treatment/expenses of *

Parent/Guardian preferred form of contact (1) *

Parent/Guardian preferred form of contact (2) *

Parent/Guardian preferred form of contact (3) *

I have read, understand, and agree with the above statements. *

Signature of parent/guardian

MEDICAL/HEALTH HISTORY - Student Name *

Birth Date *

MM/DD/YYYY

Gender *

Male

Female

PLEASE CHECK THE APPROPRIATE BOX FOR EACH ITEM AND EXPLAIN ANY "YES" RESPONSES IN THE BLANK PROVIDED - Rheumatic Fever *

Yes

Physical Limitations

Asthma, Reactive Airway Disease *

Yes

Triggers?

Other Chronic Respiratory Problems *

Yes

Explain

Allergy to Insect Bites *

Yes

Triggers?

Other Allergies *

Yes

Allergies + Severity

Diabetes *

Yes

Insulin *

Yes

Time given:

Special Diet? *

Yes

Epilepsy, Convulsions, Fits *

Yes

List any aura preceding episode

Headaches *

Yes

Frequency

Severity

Prescribed Medication

Dosage

Eye/Vision Problems *

Yes

Type

Corrective *

Glasses

Contact Lenses

Hearing Problems *

Yes

Hearing Aids *

Yes

Posture, Back, Neck, Scoliosis, Spinal Problem *

Yes

Explain

Sickle Cell Disease Trait *

Yes

Usual Symptoms

Bladder/Kidney Disease *

Yes

Frequent bedwetting/urination *

Yes

Has taken Medication/Poison Accidentally *

Yes

Long-term Effects

Other Serious Illnesses/Accidents requiring hospitalization *

Yes

Type

Date

MM/DD/YYY

Long term effects?

Other Diagnosed Medical Problems/Conditions *

Yes

Type

Necessary limits on physical activity *

Yes

Explain

Medical/Health History Form verified and completed by: *

Parent/Guardian Signature

Home Phone *

Cell Phone *

STATEMENT OF FAITH - 1. GOD is the Creator and Ruler of all things. He exists eternally in three equal persons; the Father, Son, and the Holy Spirit, known as the Trinity. God has made Himself known generally through creation, and specifically, through the Bible and Jesus Christ. Genesis 1:1, Matthew 28:19, and John 10:30 2. THE BIBLE is the Word of God, inspired by the Holy Spirit, and written through chosen authors. It speaks with the full and final authority of God in all times and at all places. It is both infallible and inerrant in the original manuscripts. We understand the Bible by the help of the Holy Spirit, Who guides the Church in its right interpretation. 2 Timothy 3:15 and 2 Peter 1:21 3. SIN is rebellion against God through disobedience. It distorts our relationship with God, with other people, with creation, and with ourselves. The effects of sin are evident in all of creation and result in our innate inability to please God. John 3:16-19, Romans 3:23, and Titus 3:5 4. SALVATION is reconciliation with God through the life, death and resurrection of Jesus Christ. In His victory we are set free from the power of evil, sin, and death. Through Him we may live in harmony with God, with others, and with creation, as well as ourselves. Ephesians 2:8-9, 2 Corinthians 5:21, Acts 16:30-31, and John 5:24 I acknowledge that my child will be instructed according to Trinity’s statement of faith. *

Signature

Date *

MM/DD/YYYY

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