Preschool Application

Preschool Application

Child Information

Child's First Name

Child's Last Name

Gender

Date of Birth

Address

City

State

Zip

Home Phone

Child Lives With:

Names and ages of siblings/have any attended CEEP?

Parent/Guardian Information

Parent/Guardian 1

Relationship to Child

First Name

Last Name

Is Parent/Guardian 1 address different than child's address?

YesNo

Address

City

State

Zip

Gender

Home Phone

Cell Phone

Email

Marital Status

MarriedLife PartnerSingleDivorced

Religious Affiliation

Congregation Emanu-El Status

MemberNon-Member

Employer Name

Occupation

Business Phone

Does your child have a second Parent/Guardian?

YesNo

Parent/Guardian 2

Relationship to Child

First Name

Last Name

Is Parent/Guardian 2 address different than child's address?

YesNo

Address

City

State

Zip

Gender

Home Phone

Cell Phone

Email

Marital Status

MarriedLife PartnerSingleDivorced

Religious Affiliation

Congregation Emanu-El Status

MemberNon-Member

Employer Name

Occupation

Business Phone

Preschool Interest

Interested in starting in Fall of:

Have you taken a tour?

YesNo

Please let us know the tour date you attended

When do you plan to attend a tour?

How did you hear about our program?

Please tell us why you are interested in enrolling your child/ren in our school:

Is there anything else that you would like to share with us about your child and/or family?

Family Photo

Please upload a family photo here

Application Fee and Payment Options

Application Fee

$

Payment Method

Credit Card/Debit CardACH/eCheck

Billing Information

Billing First Name

Billing Last Name

Billing Street

Billing City

Billing State

Billing Zip Code

Payment Information

Card Number

MM

YY

Code

Payment Information

Name on Account

Bank Name

Bank Routing Number

Bank Account Number

Account Type

CheckingSavings

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Contact Information