OAK KNOLL CHRISTIAN PRESCHOOL - "Nurturing Roots to Grow"

Oak Knoll Christian Preschool                                 

Enrollment Form                                                      

Child's Name: __________________________________Gender:_____ Birth date _____________

Address:__________________________________________________ Phone: ( ___) ________________

____3 & 4 year old class Tue.& Thurs. 9:30 -12:00 noon

____4 & 5 year old class MWF 9:30 -12:00 noon  

____ 5 year old Mon.-Thurs. 9:30 -12:00 noon .   Enrichment Class

Home Environment   Names of parents (adult caregivers):

Name: ___________________________________________________________________________________

Address: ___________________________________________________ Phone:(___)__________________

Employed at:________________________________________________ Position______________________

Hours: _________________ Work Phone #: (__)______________________

Name: __________________________________________________________________________________

Address:_____________________________________________________ Phone:(__)________________

Employed at:___________________________________________ Position: ___________________________

Hours:_______________ Work Phone #: (__ )______________________

Names and ages of siblings:

Name:__________________ Age/DOB:__________ Name:__________________ Age/DOB:__________

Name:__________________ Age/DOB:__________ Name:__________________ Age/DOB:__________

Name/relationship of other adults besides parents living in the home:

Name:_________________ Relationship:____________ Name:_________________ Relationship:____________

SociaI/Emotional Development

Describe previous child care or group experiences:

Does your child have playmates? __________ If so, what age/gender:

Briefly describe your child’s social behavior (e.g. cautious, aggressive, friendly, shy, etc.):

 Is child adopted?_____ If so, at what age? _____

Anything else we should know about the adoption:

Describe any fears your child may have and how you have dealt with them:

Your child's favorite play activities:

Describe any special interests of your child:

Child is: left-handed________ right-handed ________ not sure________

Toilet Training

Bladder trained(yes/no):________ Bowel trained(yes/no):________

Child's words for: Urinating: ____________ Bowel movement:____________

Any concerns in this area:

Miscellaneous

Does child take a regular nap?________ If so, what hours?

Any food allergies?

Describe any special developmental needs your child has that we should be aware of or possibly attend to:

Developmental Area Comments

Speech/Language __________________________________________________________________________

Motor Development ________________________________________________________________________

Self-help Skills____________________________________________________________________________

Attention Span ____________________________________________________________________________

Emotional Development _____________________________________________________________________

Social Development ________________________________________________________________________

Behavior Problems _________________________________________________________________________

Other ____________________________________________________________________________________