Program Application for FALL 2018-19 Child's Name Age Gender Gender Female Male Parent Name Mailing Adress Phone Email Address Any health issues we need to be aware of? Previous preschool/learning experiences? What type of learning environment would you like for your child? Parent Signature Date 8 + 3 = Submit Waiting List: After submitting your application, please mail a $15.00 non-refundable administrative fee.