Application: Li'l Lions Preschool Step 1 of 3 - Child & Parent Information 33% Page 1 of 2 - Child & Parent InformationCHILD INFORMATIONChild's Name* First Middle Last Birth Date* Date Format: MM slash DD slash YYYY Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child's Age on 10/15/18 (3-year-old program):Child's Age on 10/15/18 (4-year-old program):PROGRAM OF CHOICENursery School (Age 3) Options :(2 days) Tues./Thurs: Half Day (8:00AM - 11:30AM)(2 days) Tues./Thurs: Full Day (8:00AM - 2:30PM)(5 days) Mon.-Fri.: Full Day (8:00AM - 2:30PM)Preschool (Age 4) Options:(3 days) Mon./Wed./Fri.: Half Day (8:00AM - 11:30AM)(3 days) Tues./Thurs: Full Day (8:00AM - 2:30PM)(5 days) Mon.-Fri.: Full Day (8:00AM - 2:30PM)(There also is an after-school care option available for 4-year-olds who need care from 2:45PM - 5:30PM).PARENT INFORMATIONFATHER/Guardian's Name* First Last Father's Home Address (if different from child's): Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Father's Cell Number:Father's OccupationFather's EmployerFather's Email MOTHER/Guardian's Name* First Last Mother's Home Address (if different from child's) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mother's Cell Number:Mother's OccupationMother's EmployerMother's Email* Child lives with:*Both ParentsFatherMotherGuardianOtherLegal custody belongs to:*Both ParentsFatherMotherGuardianOtherAll correspondence should be sent to:* Both Parents Father Mother Guardian Other Person responsible for tuition and expenses:*What church, if any, does your family presently attend?* PREVIOUS CHILD CARE INFORMATIONHas your child previously been in childcare?*YesNo1. Name of facility/program (if yes):Child Care Program Address: Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Primary Caregiver at this program:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY 2. Name of facility/program:Child Care Program Address: Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Primary Caregiver at this program:From: Date Format: MM slash DD slash YYYY To: Date Format: MM slash DD slash YYYY ABOUT YOUR CHILDDoes your child have any special needs?*YesNoIf yes, please explain:Explain what we ought to know about your child as a learner and as a person:Sibling Name & Age:Sibling Name & Age:Sibling Name & Age:Sibling Name & Age:How did you hear about Lil' Lions Preschool?*Please list your reasons for selecting Lil' Lions Preschool:*PARENT/GUARDIAN AFFIRMATIONMy signature affirms that the information provided in the application materials is complete and accurate.FATHER/GUARDIAN: Please type your full name as a signature. By completing this form you agree that the information above is complete and accurate to the best of your knowledge:MOTHER/GUARDIAN: Please type your full name as a signature. By completing this form you agree that the information above is complete and accurate to the best of your knowledge: Thank you for applying! There is a $100 nonrefundable Registration Fee required in order to hold your child's place in the preschool. You may pay online by selecting "Credit Card" below, or choose the "Check" option and mail or bring your payment to the school.Payment MethodCredit/Debit CardCheckRegistration FeeCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Total $0.00