Maplewood Preschool Program Application

{ binding displayValue, mode=oneTime }

Age as of September 1, 2019:

Years: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Months: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Child’s Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Gender: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Home Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Primary Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Allergies / special diets {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{# pageNumbers}

Parent / Guardian Information

Parent / Guardian 1

Parent / Guardian 2

Parent / Guardian 1 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Parent / Guardian 2 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Relationship to child (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Relationship to child (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Home Telephone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Home Telephone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Cell Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Cell Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Name (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Name (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Hours at work (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Hours at work (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please list the names and birth dates of siblings of the Preschooler:

Sibling {binding ItemNumber}

Sibling Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Sibling Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{# pageNumbers}

Maplewood Preschool Program Application

Age as of September 1, 2019:

Years: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Months: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Child’s Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Gender: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Primary Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Allergies / special diets {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Parent / Guardian Information

Parent / Guardian 1

Parent / Guardian 2

Parent / Guardian 1 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Parent / Guardian 2 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Relationship to child (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Relationship to child (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Name (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Name (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Hours at work (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Hours at work (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please list the names and birth dates of siblings of the Preschooler:

Sibling {binding ItemNumber}

Sibling Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Sibling Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Child’s History:

Has your child attended school/program prior to Maplewood Preschool? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What is the name of the school/program they attended? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are there health issues or fears the Maplewood staff should be aware of? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Are there family situations or concerns the Maplewood staff should be aware of? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please describe any developmental history of your child which may be relevant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Application Details

Preschool Days: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Classroom Request ((We do our best, however we cannot guarantee placement.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please note: $200 non-refundable deposit is required with your application. ($100 for returning students)

Maplewood Preschool Program Application

Age as of September 1, 2019:

Years: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Months: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Child’s Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Gender: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Primary Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Allergies / special diets {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Parent / Guardian Information

Parent / Guardian 1

Parent / Guardian 2

Parent / Guardian 1 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Parent / Guardian 2 Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Relationship to child (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Relationship to child (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Telephone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Name (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Name (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Address (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Address (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Phone (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Phone (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Hours at work (1) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Hours at work (2) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please list the names and birth dates of siblings of the Preschooler:

Sibling {binding ItemNumber}

Sibling Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Sibling Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Child’s History:

Has your child attended school/program prior to Maplewood Preschool? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What is the name of the school/program they attended? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are there health issues or fears the Maplewood staff should be aware of? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Are there family situations or concerns the Maplewood staff should be aware of? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please describe any developmental history of your child which may be relevant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Application Details

Preschool Days: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Classroom Request ((We do our best, however we cannot guarantee placement.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please note: $200 non-refundable deposit is required with your application. ($100 for returning students)