Amanda Clearcreek Preschool Intent to Enroll
The Amanda Clearcreek Local School District is moving forward to open our own preschool classrooms to be housed at Amanda Clearcreek Primary School. The program is designed to serve six to eight identified special needs students, ages  3-4-5, with the option to include four to eight typically developing peers. Please complete this Intent to Enroll if your child meets either of these descriptions.

Typical preschool applications are not accepted before the child is 2 1/2 years old.

A typical child must be at least 3 1/2 years old and toilet trained to attend preschool. A student with a disability must be 3 years old and toilet trained is preferred.

First preference will be given to children who live in the district and will be kindergarten eligible in the fall of the following year.

Each child will need a physical and dental examination within thirty days of the start of school.

The cost of the program will be $120 per week for typical students and will have an income-based sliding scale available for families. Students identified with a disability will attend free of charge.

You will be notified of screening and registration information at a later date. If you have questions, please email terrip@amanda.k12.oh.us

COMPLETING THIS FORM DOES NOT GUARANTEE ACCEPTANCE
Sign in to Google to save your progress. Learn more
Child Last Name *
Child First Name *
Child Nickname or Called name if something different than first name
Age *
Date of Birth *
MM
/
DD
/
YYYY
School District of Residence *
Are you an employee of Amanda Clearcreek Local Schools *
Required
Does your child receive any of the following therapy services *
Required
Does your child have any medical diagnosis or other diagnosis that may qualify them for additional services? Please explain below
Does your child have a chronic condition that requires medication? If so, please explain below
Does your child feed himself/herself *
Required
Does your child drink from a cup *
What kind of chair does your child sit in while eating? *
Behavior Information-Please check all that apply *
Required
Is your child toilet trained *
How does your child communicate the need to go to the bathroom *
Does your child dress himself/herself *
Required
How does your child currently spend the day *
Required
Does your child make friends easily *
Required
Does your child share toys *
Required
Does your child play with other children during the day?
What does your child play with? *
How does your child express his/her needs *
What method of discipline is used by mother? *
What method of discipline is used by father? *
How do you comfort your child?
When your child plays: Please check all that apply *
Required
Does your child play with (Please check all that apply) *
Required
Does your child separate easily from parent? *
Describe your child: *
Required
Does your child nap *
What is your goal for your child in preschool? *
Other information that may be important to the school district
Parent Name *
Email *
Contact phone number *
Preferred method of communication *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Amanda-Clearcreek LSD. Report Abuse
Google Forms