The Holloway Preschool

2010/2011 School Year

Applications for Admissions

Welcome to The Holloway Preschool

Below you will find procedures for registering your child. These steps are to be followed and completed by guardians.

Admission Procedure

Please complete our application for admission (one application form per family.) Kindly ensure that the requirements are read, completed and submitted.

We are interested in enrolling:

Check all that apply

Immediately, next available space
January
June
September

Student Information

Name*

First

Middle

Last

Address*

Street

City

State

Zip

Phone Number*

###

####

Date of Birth*

Day

Year

Place of Birth

Place

Sex*

Male Female

Other Languages Spoken

Languages

Name of Previous School

School Name

Name of Teacher

Name

School's Number*

###

####

Family Information

Parent/Guardian 1 (with whom children resides)

Name*

First

Middle

Last

Address
(if different from child)

Street

City

State

Zip

Occupation

Employer

Work Phone

###

####

Home Phone

###

####

Cell Phone

###

####

E-mail Address

Ex: johndoe@domain.com

Parent/Guardian 2

Name*

First

Middle

Last

Address
(if different from child)

Street

City

State

Zip

Occupation

Employer

Work Phone

###

####

Home Phone

###

####

Cell Phone

###

####

E-mail Address

Ex: johndoe@domain.com

Health Information

Family Health Plan Provider

Provider Name

Health Care Number

Number

Phone Number*

###

####

Plans is provided by

Father Mother Both

2010/2011 School Year

Applications for Admissions

Welcome to The Holloway Preschool

Admission Procedure

We are interested in enrolling:

Student Information

Name*

Address*

Phone Number*

Date of Birth*

Place of Birth

Sex*

Other Languages Spoken

Name of Previous School

Name of Teacher

School's Number*

Family Information

Parent/Guardian 1 (with whom children resides)

Name*

Address (if different from child)

Occupation

Employer

Work Phone

Home Phone

Cell Phone

E-mail Address

Parent/Guardian 2

Name*

Address (if different from child)

Occupation

Employer

Work Phone

Home Phone

Cell Phone

E-mail Address

Health Information

Family Health Plan Provider

Health Care Number

Phone Number*

Plans is provided by

Does your child have any special needs that we should be aware of?

If yes, please explain how we can be of support

We are appreciative of your interest in The Holloway Preschool; please answer the following questions so that we may better understand your needs.

How did you hear about The Holloway Preschool?

which ther schools have you considered as possibilities?

Please indicate the criteria that influenced your decision to apply to The Holloway Preschool?

Address
(if different from child)

Address
(if different from child)