Preschool Application

Preschool Application for Admission

"*" indicates required fields

Child Name*

First Middle Last

Child's Nickname

Child's Birth Date*

Sex*

Preferred Phone Number*

Current School*

Columbia Academy Location*

Desired Enrollment Date*

Desired Schedule*

Please note the Infant/Toddler Program is Full Days Only

Parent/Guardian "A"

Name*

First Middle Last

Relationship to Student*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Email*

Employer*

Occupation*

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone*

Parent/Guardian "A" -Student lives with

Parent/Guardian "A" - Responsible for Tuition

If not responsible for tuition, please explain:

Parent/Guardian "B"

Name

First Middle Last

Relationship to Student

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Employer

Occupation

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Parent/Guardian "B" - Student Lives With

Parent/Guardian "B" - Responsible for Tuition

If not responsible for Tuition, please explain:

Signature

Registration Fee: $100.00 This non-refundable and non-transferrable registration fee must accompany each new student registration. Tuition Deposit: Equal to two weeks tuition this non-refundable and non-transferable fee must accompany each new student registration and will be credited to the last two weeks of tuition upon withdrawal. If no notice or less than two weeks’ notice is given, the deposit is forfeited whether or not the child attends. Columbia Academy will hold a space for newborns until the child is 12 weeks old; for all other age groups up to 4 weeks after registration.

Parent/Guardian "A" Signature*

Your signature confirms that you have read and understand the registration fee and tuition depost details.

Date*

Parent/Guardian "B" Signature*

Your signature confirms that you have read and understand the registration fee and tuition depost details.

Date*

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