St. Francis Preschool Application

St. Francis Preschool Application
Dear Parents and Guardians,

Thank you for your interest in St. Francis Preschool at the St. Francis Intergenerational Center. We look forward to collaborating with you on your child’s educational journey, which includes special opportunities for the young to interact with the elderly in shared experiences. For your child to be accepted for admission, an interview must be scheduled, and the application form and all other supporting documents as noted below must be received before the child’s first day of school.

o Completed Application form

o Copy of child’s Birth Certificate

o Copy of Baptismal Certificate, if applicable

o Copy of Report Card or Progress Report, if applicable

o Test results from DOE or other agencies, if applicable

o $25 Application Fee (non-refundable)

Incomplete Applications will not be returned.

Following review of your application and completed interview, you will be notified by acceptance letter. To confirm your child’s enrollment, the remaining supporting fees and documents must be submitted.

o $150 Registration Fee (non-refundable)

o $100 Deposit

o Pupil Health Form (Form 14) (Current TB clearance & physical required upon entrance)

o Signed Parent Handbook Statement of Agreement

o Signed Authorization Form

Should you have any questions or concerns, please call the Preschool Office at (808) 681-0100.

Sincerely,

Rochelle Takata
Director

Applicant Information
My child will attend
Desired Start Date

MonthDayYear
Date
Child's Full Name

First NameMiddle NameLast Name
Child's Nickname
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Family Information
Parent/Guardian 1 Full Name

First NameLast Name
Relationship to Child
Parent/Guardian 1 Email Address
example@example.com
Parent/Guardian 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Occupation/Employer
Parent/Guardian 2 Full Name

First NameLast Name
Relationship to Child (Parent/Guardian 2)
Parent/Guardian 2 Email Address
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Occupation/Employer
Parents' Marital Status
Who has physical custody of the applicant?
Relationship to Applicant
If living separately, do you desire correspondence sent to both parents/guardians?
The Hawaii Catholic Schools must report to the National Catholic Education Association and local agencies summary data on the gender, religion, and ethnic backgrounds of our students. Therefore, it is required that each person applying for admission to a Catholic school indicate his/her gender, religion and ethnic background on the application form. This information does not affect determination of admission. The ethnic designations are used to indicate a general group to which a person appears to belong or identifies with. Thank you for your cooperation.
Religion
Ethnic Background
Language(s) Spoken at Home

Other
We/I certify that the above information is complete and accurate. Any information found to be inaccurate might be considered grounds for dismissal from this school. I understand that all other requested documents must be received by stated due dates or as space permits in order for my child to be considered for enrollment.
Parent/Guardian 1 Signature & Date
Parent/Guardian 2 Signature & Date
Medical Information
Child's Physician
Physician Phone Number
Child's Dentist
Dentist Phone Number
My child has health insurance
If yes, which health insurance plan is your child on?

Other
My child receives regular care for a medical condition
If yes, please explain
Please list all allergies and reactions
NOTE: Lunch & snacks are provided at our facility. Menus are posted monthly. For children who are lactose intolerant, parent must provide a milk substitute. For children who have a special diet (e.g. no pork), parent must provide the meal for the day.

In case of an emergency, my child will be taken to the nearest emergency facility. I give my consent for school authorities to take appropriate action for the safety and welfare of my child.
Parent/Guardian 1 Signature & Date
Parent/Guardian 2 Signature & Date
Additional Information
How did you hear about St. Francis Preschool?

Other
Please check all organizations you have applied to regarding tuition subsidies
Please list the names of other preschools your child has attended
Why did you choose St. Francis Preschool for your child?
Please share any other pertinent information about your child that would be helpful to better know, understand, and work with your child.
Supporting Documents
Birth Certificate (Required)

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Baptismal Certificate (if applicable)

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Copy of Report Card or Progress Report (if applicable)

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Test results from DOE or other agencies (if applicable)

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Application Fee Payment

Application Fee

Preschool Application Fee

Non-refundable application fee for preschool admission.

$25.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

St. Francis Preschool Application

Applicant Information

Family Information

Medical Information

Additional Information

Supporting Documents

Application Fee Payment

Application Fee*

Application Fee