Application Form For Admission printable pdf download

St. John the Apostle Preschool

101 Oakcrest Manor Drive, NE

Leesburg, Virginia 20176

(703) 777-7873

2016-2017 APPLICATION FOR ADMISSION

**Please note: It is very important that all blanks be completed. Incomplete applications cannot

be considered for registration. Thank you for your help.

DATE OF APPLICATION______/______/______

Student’s Name: _____________________________ __________________

_______________ Sex: ______

Last

First

Middle

Student’s Preferred Name: ____________________ Date of Birth: ____/____/____ Age on 9/30/16: ______

Check one: 1) currently enrolled ______ 2) sibling of current/past student ______ 3) new student _______

Choice of classes and one of the “I will” choices below it.

Desired Class Placement: Please check your 1

_____ 3 year-old Morning Class ____ 3 year-old Afternoon Class

_____ 4 year-old Morning Class ____ 4 year-old Afternoon Class

_____ I will only accept my 1

Choice.

_____ I will accept either a morning or afternoon class placement, but I prefer my 1

Choice.

Are there any special circumstances that we should consider when deciding the morning or afternoon

placement for your child (nap times do not qualify)? ________________________________________________

Parish that you attend: _____________________ Is your child a baptized Catholic? yes ______ no_______

(

does not have to be Catholic)

Mother

Father

Parents or Legal Guardians:

_______________________________ _______________________________

Mailing Address/Street:

_______________________________ _______________________________

City/State/Zip Code:

_______________________________

Email:

_______________________________

Home Telephone:

_______________________________

Work Telephone:

_______________________________

Cell Phone:

_______________________________

Current Occupation:

_______________________________

Former Occupation:

_______________________________

Religion:

_______________________________

Emergency Contact Person/Telephone (cannot be parent):____________________________/_____________

Please list siblings & ages. Circle any St. John’s “alumni” and give the years of attendance at our Preschool:

____________________________________________________________________________________________

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PLEASE TURN OVER and CONTINUE to PAGE 2)

Application Form For Admission

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