PreK - 1st Grade Application

Click here for the 2nd - 12th Grade Application

"*" indicates required fields

Student Information

Student Name*

First Middle Last

Nickname

To be used at school by peers & teachers

Address*

Street Address City State / Province / Region ZIP / Postal Code

Primary Telephone*

Can the phone number listed above receive SMS messages (text)?*

Date of Birth*

Month

Day

Year

Male or Female?*

Male

Female

Is your child a U.S. citizen?*

Yes

Applying for:*

Preschool T/Th

Preschool M/W/F

Kindergarten

1st Grade

Family Information

With whom does the applicant reside?*

Are there special child custody provisions?*

If yes, please provide documentation.

Yes

Child Custody Documentation*

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Father/Male Guardian

Name*

First Last

Email*

Primary Phone*

Secondary Phone

Can the Primary Phone number listed above receive SMS messages (text)?*

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Marital Status*

Spouse Living at Home

Separated

Divorced

Spouse Deceased

Employer*

Employer Address*

Street Address City State / Province / Region ZIP / Postal Code

Mother/Female Guardian

Name*

First Last

Email*

Primary Phone*

Secondary Phone

Can the Primary Phone number listed above receive SMS messages (text)?*

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Marital Status*

Spouse Living at Home

Separated

Divorced

Spouse Deceased

Employer*

Employer Address*

Street Address City State / Province / Region ZIP / Postal Code

Are there siblings in the home?*

Yes

What are their names and ages?*

Financial Information

Are you interested in applying for financial assistance (K and up)?*

Yes

Financial obligation for tuitions & fees goes to:*

Father Only

Both Parents

Mother Only

If someone other than the parent/guardian listed above is responsible for the financial obligations while this student is enrolled at Mount Zion, please complete the following information:

Name

First Last

Relationship to Student

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Work Phone

Cell Phone

Email Address

Education & History

Please list all schools the applicant previously attended starting with the most recent if applicable:*

Name of School

City/State

Phone Number

Grade(s)

Potty-Training*

Check any and all that apply. Use space provided to elaborate, as needed.

My child is fully potty trained (see specific list below)

Successfully takes care of all bathroom needs.
Wipes, dresses, flushes and washes hands independently.
Realizes need to use bathroom without prompting.
Accidents are rare, but when it happens can change without assistance.
Does not have accidents at naptime.

My child is in the process of potty training (see specific list below)

May need help with taking care of bathroom needs.
May need moral support while taking care of bathroom needs.
Reminders to wipe, flush and wash. Some assistance to dress.
Needs reminders to use the bathroom.
Still has accidents during the day or during nap. May need assistance after an accident.

My child will be working on this over the summer, so he or she will be ready in the fall. I understand that this means that my child will be conditionally accepted.

Potty-Training Additional Comments

Does the applicant have pottying needs or aids?*

ie: pull-ups, needs assistance, etc.

Yes

If yes, explain:*

Has the applicant ever received public or private services for an identified learning disability?*

Yes

Please explain:*

Are there any medical diagnoses that could impact his or her success in a classroom environment?*

Yes

If yes, explain:*

Does the applicant have any history of health problems (physical or emotional)?*

Yes

If yes, explain:*

Is the applicant on medication?*

Yes

If yes, type(s)*

If yes, what is the intended result(s) of the medication(s)?*

Does the applicant have any type of learning disability, difficulty or limitations?*

Yes

If yes, explain:*

Is the applicant currently involved in any special programs or receiving any special services from your school or from a private source?*

Speech Therapy

Physical Therapy

Occupational Therapy

None

Other

If other, explain:*

If so, please provide documentation of testing, which was done to qualify the applicant.

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

At Mount Zion Christian Schools, we love our students and their families. Please take a few minutes to give us some parental insight to help us get to know your child even better.

What are your child’s favorite activities?*

What is your child looking forward to most about school?*

What are your goals/desires for your child this year in school?*

Does your child have trouble transitioning away from you?*

My child easily transitions to another caregiver.

My child is reluctant to leave parent.

My child has a difficult time separating.

My child has not had experience separating from parents.

Other

If other, explain:*

If they do have trouble separating , what have you found to be helpful?

Behavior observations

Check all that apply. Use space provided to elaborate, if needed.

Has temper tantrums

Can be shy

Sensitive to noise or other stimuli

Other

If other, explain:*

Behavior observations comments

Social play observations*

Check all that apply. Use space provided to elaborate, if needed.

Trouble sharing/ Cooperating with peers

Tends to observe play of peers

Tends to play side by side with peers

Tends to play interactively with peers

Does not typically play with peers

Social play observations comments

Health Concerns, allergies etc.

Has food or product allergies

Other allergies or sensitivities

Precautions (things you would like us to consider or be aware of)

Pertinent Medical History of Child (premature birth, speech or developmental delays, previous or current medical conditions, early intervention etc.)

Health concerns additional comments*

Bed time*

Hours

Minutes

AM/PM

Wake time*

Hours

Minutes

AM/PM

Naps*

My child takes a nap every day.

My child takes a nap most days.

My child rarely or never takes a nap

If yes, what times?*

Parent Information

Is there anything you would like to share about your child with his or her prospective teacher?

Please write a paragraph or two to describe why you would like your son/daughter to attend Mount Zion Christian Schools:*

How did you hear about Mount Zion Christian Schools?*

Consent*

I have completed this student application truthfully, to the best of my knowledge and give permission for Mount Zion Christian Schools’ administration to call past and current teachers.

Consent*

I understand Mount Zion is a Christian preschool, kindergarten, and 1st grade. Further, I understand that in order to enroll in Mount Zion’s Elementary program and beyond I will need to sign their Statement of Faith.

Consent*

I understand that all preschool enrollments are “conditional” based on my child’s demonstrated ability to meet pottying requirements as listed above.

Father/Guardian Signature

Date

Month

Day

Year

Mother/Guardian Signature

Date

Month

Day

Year