Living Praise Early Learning Academy

Online Preschool Application Form
Please fill in the form completely

Child’s Name A value is required.    -   Nickname

Street Address A value is required.     City A value is required.     ZIP A value is required.

Second Address     City     ZIP

Date of Birth A value is required.          Male      Female
Please make a selection.

Please select program

2 – 5 years
Please make a selection.
Full Time (6:00am-6:00pm) Part Time (8:00am-1:00pm)
Please make a selection.
5 days a week 3 days a week 2 days a week
Please make a selection.

Days attending

AM: Monday Tuesday Wednesday Thursday Friday Minimum number of selections not met.Maximum number of selections exceeded.
AM Program Arrival Time A value is required. -- AM Program Departure Time A value is required.

Minimum number of selections not met.Maximum number of selections exceeded. PM: Monday Tuesday Wednesday Thursday Friday Minimum number of selections not met.Maximum number of selections exceeded.
PM Program Arrival Time A value is required. -- PM Program Depature Time A value is required.

Tuition Schedule
	5 days	3 days	2 days
	2 - 5 years	2 - 5 years	2 - 5 years
Full Day 6:00AM – 6:00PM	$165.00/week	$110.00/week	$105.00/week
Full Day - Sibling 6:00AM – 6:00PM	$145.00/week	$110.00/week	$110.00/week
Half Day 8:00AM – 1:00PM	$125.00/week	$95.00/week	$75.00/week
Checks Made Payable to: Living Praise Early Learning Academy Cash, Check or Money Order

Please insert N/A for not applicable fields:

Mother’s Name

A value is required. Home Phone A value is required. Cell Phone A value is required. Business Phone A value is required.

Place of Employment A value is required. Occupation A value is required.

Email Address A value is required.

Please insert N/A for not applicable fields:

Father’s Name A value is required.

Home Phone A value is required. Cell Phone A value is required. Business Phone A value is required.

Place of Employment A value is required. Occupation A value is required.

Email Address A value is required.

Child lives with: Mother Father Both Guardian Other: Please make a selection.

I certify that all the above information on this application form is true and correct to the best of my knowledge.

Certified by A value is required. Email Address:

Primary Contact Name A value is required. Primary Contact Phone A value is required.

Please remember there will be a non-refundable $100 Application Fee, you will be contacted prior to the processing of the application.

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