Basehor-Linwood Early Learning Center 3-year old Preschool Application

Application for 2020-2021 Basehor-Linwood 3-year old Preschool Program

Basehor-Linwood Fee-Based Preschool Program offering high-quality early learning cultivating kindergarten readiness for the Basehor-Linwood community. This program is available for children not eligible for the Early Childhood Special Education Program. Eligible children will need to turn 3 years old by August 31, 2020 and be toilet trained.
Details:
·      $250 a month (reduced rate for free/reduced eligible children)
·      Transportation will not be available for the 2020-21 school year
·      Classes meet five days a week, Monday – Friday
·      The morning session is from 8:15 - 11:15
·      The afternoon session is from 12:30 – 3:30
·      All-day classes are not offered at this time

. Updated immunizations and birth certificates must be on file before the 1st day of school

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* 1. Child 1 Information

Child's Name

Sex

Age

Date of Birth

Home Address (Street)

City

State

Zip

Home Phone Number

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* 2. Parent Information

Mother's Name

Mother's Phone Number

Mother's Email Address

Mother's Address (If different from child's)

Mother's Place of Employment

Mother's Work Phone Number

Mother's Work Email (if different from home email)

Mother's Employer's Address

Father's Name

Father's Phone Number

Father's Email Address

Father's Address (if different from mother's)

Father's Place of Employment

Father's Work Phone Number

Father's Work Email (if different from home email)

Father's Employment Address

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* 3. Child's Living Arrangements:

Both Parents

Mother

Father

Other (please specify)

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* 4. Child's Legal Guardian(s):

Both Parents

Mother

Father

Other (please specify)

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* 5. My child may be released to the person completing this application or to the following:

Name

Street Address

Telephone Number

Relationships to child

Relationship to Parent(s) or Guardian

Other identifying information

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* 6. My child may be released to the following additional person:

Name

Street Address

Telephone Number

Relationships to child

Relationship to Parent(s) or Guardian

Other identifying information

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* 7. Person to contact in the case of emergency when parent/guardian cannot be reached:

Name & Telephone Number

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* 8. All children enrolled at Basehor-Linwood ELC are required to have a current physical and up-to-date immunizations at the time of enrollment. It is the parent's/guardian's responsibility to keep all immunizations up-to-date.

Child's doctor or clinic name:

Doctor/clinic phone #:

My child has the following special needs:

The following special accommodations may be required to most effectively meet my child's needs while at the center:

My child is currently on medication(s) prescribed for long-term continuous use and/or has the following pre-existing illness, allergies or health concerns:

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* 9. Which session would you prefer:

A.M. - 8:15 - 11:15

P.M. - 12:30 - 3:30

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* 10. Please provide any additional information here:

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* 11. Please type your full name to validate the information provided is accurate and serve as your electronic signature for application to the ELC childcare center. **Parents will be required to sign an Emergency/Medical Authorization before childcare services will start.