Admission Application Pre K - Al
Al-Huda Pre-School Where Love, Learning, & Guidance are Part of the Curriculum 2015-2016 ADMISSION APPLICATION GRADE APPLYING FOR: APPLICANT’S NAME For Office Use Only: Date Received: _____/_____/_____ Time Received: Application Fee: Immunization Records: PRE-K 3 PRE-K 4 ____Birth Certificate:__________ (PLEASE CIRCLE ONE) Male Female Last First Middle Street Address City Home Phone (Include area code) Social Security Number Date of Birth Primary Language Spoken Place of Birth State Zip Other Languages Yes No Does your child have any special learning, speech, physical or behavioral problems? If yes, please explain. Yes No Does your child have any special needs we should be aware of? If yes, please explain. Applicant lives with (Please check all that apply): Mother Father FAMILY INFORMATION Other: _______________________ Father /Guardian _____________________________________________ Name _________________________________________________ Business Phone _____________________________________________ Home Address _________________________________________________ Occupation _____________________________________________ City State Zip _________________________________________________ Place of Employment _____________________________________________ Home Phone _________________________________________________ Email Address _____________________________________________ Cell Phone _________________________________________________ • 1007 Rana Villa Avenue, Camp Hill, PA 17011, Ph: 717-737-5395, Fax: 717-889-4854, Email: [email protected] • Al-Huda Pre-School Where Love, Learning, & Guidance are Part of the Curriculum Mother/Guardian GENERAL INFORMATION _____________________________________________ Name _________________________________________________ Business Phone _____________________________________________ Home Address _________________________________________________ Occupation _____________________________________________ City State Zip _________________________________________________ Place of Employment _____________________________________________ Home Phone _________________________________________________ Email Address _____________________________________________ Cell Phone _________________________________________________ Names, ages, and grades of brothers: Names, ages, and grades of sisters: ____________________________________________ _________________________________________________ ____________________________________________ _________________________________________________ Yes Yes No Are you interested in working/volunteering at the pre-school? Yes No Is your child toilet-trained? No Are you able to donate any supplies to the pre-school? Religious affiliation What are the most important qualities you are looking for in a pre-school program for your child? Applicant was referred by: _____________________________________________________________________________ EMERGENCY CONTACTS Name: _______________________________ Relationship: __________________Daytime Phone: _________________ Name: _______________________________Relationship: __________________Daytime Phone: __________________ • 1007 Rana Villa Avenue, Camp Hill, PA 17011, Ph: 717-737-5395, Fax: 717-889-4854, Email: [email protected] • Al-Huda Pre-School Where Love, Learning, & Guidance are Part of the Curriculum COMPLETED The following materials constitute a complete application for Admissions: APPLICATION 1. This application form filled out COMPLETELY. 2. $45.00 non-refundable application fee 3. Birth Certificate 4. Medical Form 5. Dental Form 6. Up to date Immunization Record. Please be aware that enrollment is limited and is on a first come first serve basis. Please return your completed application as soon as possible to the school’s main office. Only completed applications will be reviewed and considered for admission. Please inform the school’s office for any address changes as soon as they occur. Be advised that by signing this application, you are accepting to follow the rules and regulations of Al-Huda School. May Allah help us to learn, act and teach what only pleases HIM. Name of parent/guardian (please print) _________________________________________________ SIGNATURE Signature of Parent/Guardian Date • 1007 Rana Villa Avenue, Camp Hill, PA 17011, Ph: 717-737-5395, Fax: 717-889-4854, Email: [email protected] •
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