Online Application Form To register your child, please fill out this form and then continue to our payment portal to pay your enrollment fee and last month’s tuition (May 2020). Both the enrollment fee and May 2020 tuition are nonrefundable and nontransferable to any other month. (The enrollment fee includes a registration fee, an activity fee and a supply fee.) Choose a class schedule for your child:* 1 Year Old Class: Tuesday & Thursday 2 Year Old Class: Tuesday & Thursday 2 Year Old Class: Monday, Wednesday, Friday 3 Year Old Class: Monday, Wednesday, Friday 3 Year Old Class: Monday - Friday Pre-K (4 Year Old) Class: Monday - Thursday Pre-K (4 Year Old) Class: Monday - Friday Child's Name* Name to be called at school (if different) Child's Birthdate* MM slash DD slash YYYY Sex Male Female Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary phone*Primary phone is* Cell/Mobile Home Work Parent/Guardian name(s)* Father's Employer / Occupation Mother's Employer / Occupation Church Affiliation Primary Email* How many children in your family?This child is number?(Oldest is number 1)Has your child been in a nursery/preschool before? No Yes Name of School Physician’s name and phone number Children with special needs will be considered for admission if to do so would not place an undue burden (significant difficulty, and/or expense) on the preschool program. If your child has any special needs (e.g. speech/language delays, fine and/or gross motor delays, physical limitations, behavior/emotional disorders) please list them below as well as any therapy your child is currently receiving. Admission to the preschool will be at the discretion of the Director.List special needs and therapy information here:Does your child have any allergies or medical conditions?All children will be considered for admission to St. Stephen’s Episcopal Preschool regardless of race or faith. With exception to our two day two year old class, August 31 is honored as the birthday cut-off date for class assignment. December 31 is the birthday cut-off date for the two day two year old class. Pre-K students must be fully toilet trained to attend preschool. Five day three year olds need not be fully toilet trained at the beginning of the school year but must be in the process of toilet training. They must be fully toilet trained by November 1, 2019. Three year olds in the three day class need not be fully toilet trained at the beginning of the school year but must to be in the process of toilet training. They must be fully toilet trained by mid-January, 2020. Two year olds need not be toilet trained to attend preschool. A health form must be completed by your child’s physician and returned to St. Stephen’s Episcopal Preschool. This health form must be on file in the preschool office for your child to attend school. St. Stephen’s Episcopal Preschool complies with the N.C. State immunization guidelines. If you have any questions, please call the Director at 489-6789 before submitting this form.