Preschool Application

Child's Name*

First Last

Child's Date of Birth*

MM

DD

YYYY

Parent/Guardian 1 Name

First Last

Parent/Guardian 2 Name

First Last

Parent/Guardian 1 Address*

Street Address Address Line 2 City State Zip Code

Parent/Guardian 2 Address

Street Address Address Line 2 City State Zip Code

Parent/Guardian 1 Email*

Parent/Guardian 2 Email

Parent/Guardian 1 Cell Phone*

Parent/Guardian 2 Cell Phone

Parent/Guardian 1 Occupation

Parent/Guardian 1 Employer

Parent/Guardian 2 Occupation

Parent/Guardian 2 Employer

Parent/Guardian 1 Relationship to Child*

Parent/Guardian 2 Relationship to Child

Child lives with

About Your Child

Briefly describe your child's personality and temperament.*

Briefly describe any significant events in your child's medical or developmental history that would be helpful for us to know.*

Any evaluations or information on special services received can be submitted to Nili Shriber, Director of Preschool at NShriber@14streety.org.

Please list any allergies your child has if applicable.

Please list any siblings, their ages, and where they attend school

How did you hear about our program?

Prelude to Preschool
Other 14Y Class or Event

Please indicate which program and schedule you're interested in.

Preschool (2–4 Years)

Preschool Twos (2 by September 2020)

3 Days (Tu-W-Th) |9:00 AM – 1:00 PM
5 Days (M-F) | 9:00 AM – 1:00 PM

Preschool Threes (3 by September 2020)

5 Days (M-F) Full Day | 9:00 AM – 3:00 PM
5 Days (M-F) | 9:00 AM – 1:00 PM

Preschool Fours (4 by September 2020)

5 Days (M-F) Full Day | 9:00 AM – 3:00 PM
5 Days (M-F) | 9:00 AM – 1:00 PM

Prelude to Preschool (15 – 34 Months)

This program is rolling admission.

Prelude to Preschool Programs with Caregivers Gradually Phased-Out (15 – 34 months by September 2020) Full Year Option

2 Days (M/W) 9:15-11:00 AM
2 Days (T/TH) 9:15-11:00 AM
2 Days (M/W) 11:15 AM -1:00 PM
2 Days (T/TH) 11:15 AM-1:00 PM

Prelude to Preschool Programs with Caregivers Gradually Phased-Out (15 – 34 months by September 2020) Half-Year Winter Option

2 mornings per week | 1 hour and 45 minutes each session

This program runs January 2020 – June 2020.

Application Fee

Please note that a non-refundable $75 application fee is payable by credit card.

Preschool Application

Total

$0.00

Credit Card

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

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14th Street Y Preschool 2020 – 2021

If your child is 2 by September 1, 2020, we welcome you to apply for the 14th Street Y Preschool.

Prelude to Preschool & Preschool Application 2020 – 2021

About Your Child

Please indicate which program and schedule you're interested in.

Preschool (2–4 Years)

Prelude to Preschool (15 – 34 Months)

Application Fee

Login to 14th Street Y

Preschool Application

14th Street Y Preschool 2020 – 2021

If your child is 2 by September 1, 2020, we welcome you to apply for the 14th Street Y Preschool.

Prelude to Preschool & Preschool Application 2020 – 2021

About Your Child

Please indicate which program and schedule you're interested in.

Preschool (2–4 Years)

Prelude to Preschool (15 – 34 Months)

Application Fee