2024-2025 Adena Preschool Interest Form

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Adena Elementary Preschool is beginning the enrollment process for it's three 5-Star Step Up To Quality rated preschool classrooms for the 2024-2025 school year.

Please complete the information below and be sure to submit your form. Once this form has been completed, a member of our Preschool Staff will contact you with further information.

Collecting the following pieces of documents and having them ready when we call will be very helpful.
* Photo ID for Parent or Guardian
* Copy of Student's Birth Certificate
* Student's Immunization Records
* Custody Orders (if applicable)
* Proof of Income (for those applying for the ECE grant)
* Proof of Residency (official lease/rental agreement, property tax statement, utility bill within last 30 days, mortgage coupon/closing statement, or the Adena Local Schools Doubled Up form with notary seal)

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Child's Gender *

Male

Female

Parent/Guardian Name(s) *

Primary Parent Contact Number (please add area code) *

Primary Parent Email Address *

Child's Address *

Transportation Plan: *

My child will ride the bus to and from school.

My child will ride a bus to and from an address other than our home address (second stop, only one per child with school approval)

My child will be transported to and from school by car.

My child will ride a bus and we will transport them, depending on the day and/or time.

My child will ride a bus to and from home and from a second stop, depending on the day and/or time.

I'm not sure at this time.

Please use the chart below to determine your eligibility for a grant spot. Grant spots are filled on a first come, first served basis. Children must be 4 on or before August 1, 2024.

Enrollment Options You Would Consider: (Check All That Would Apply) *

Full Day Classroom, 4 Days per Week, $200/month tuition

Full Day Classroom, 2 Days per Week, $120/month tuition

Full Day Classroom, 4 Days per Week, Grant (based on above income guideline)

Full Day Classroom, 2 Days per Week, Grant (based on above income guideline)

Required

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