Renaissance
School
867
North Pleasant Street, Amherst, MA
Application for
Enrollment
Date of
application ____________
Child’s
Name __________________________________ Male or Female (circle one)
Date of
Birth _______________________Telephone
______________________
Address
_________________________________________________________
Parent/Guardian
_________________________ Telephone __________________
Parent’s
Address
___________________________________________________
Parent’s
Occupation ____________________________Email
________________
Parent/Guardian_________________________
Telephone __________________
Parent’s
Address
___________________________________________________
Parent’s
Occupation ____________________________Email
________________
What is
the native language spoken in your child’s home?
_____________________
If it
is other than English, does your child speak/understand English?
_____________
Has
your child attended preschool before? (please list organized experiences with
other children such as Storytime at library, family day care, etc.)
____________________
When
would you like your child to begin preschool?_________________ Check preferred days to attend: (please choose 3 or 4 days) ___Monday ___Tuesday ___Wednesday ___Thursday
How do you think your child will separate from you at
preschool?______________________
Please
mention your reasons for sending your child to our program
______________
Tell us
about your child…. what are his/her strengths/interests?
_______________________________________________________________
_______________________________________________________________
Does
your child have any allergies/special needs we should be aware of?
________________
_______________________________________________________________
How did
you hear about our program?
___________________________________
*To complete the application
process, please include a deposit of $100.00 with this application. A $20.00 registration fee is due upon enrollment. Please make checks payable to "Renaissance School Inc." Thank you
Office
Use Only: Date Deposit Received______ Accepted?___
Child’s age at admission _____