Early Childhood Center Application

IMPORTANT: Please call 475-1729 for available openings BEFORE submitting an application. Thank you!

1.
*

Please enroll my child for the following days:

(2 required)
Monday
Tuesday
Wednesday
Thursday
Friday
2.
*

Choose which program your child will attend:

3.
*

Desired start date:

4.
*

Child's Full Name:

5.

Child's Nick Name (if any):

6.
*

Home Address (including City, State and Zipcode):

7.
*

Phone Number:

8.
*

Child's Birthdate:

9.
*

Child's Place of Birth:

10.
*

Child's Sex:

Male   Female

Family Information

Father's Information
11.

Father's Name:

12.

Employer:

13.

Business Address:

14.

Business Telephone:

15.

Cell Phone:

16.

Email Address:

Mother's Information
17.

Mother's Name:

18.

Employer:

19.

Business Address:

20.

Business Telephone:

21.

Cell Phone:

22.

Email Address:

23.

Please list the names and grades of any siblings currently attending Nampa Christian Schools:

24.

If both parents are not living in the home with the student, clarify briefly:

25.
*

Which church do you currently attend:

26.

How did you learn about the Nampa Christian Early Childhood Center?

27.
*

Please indicate below whether or not you would allow your child's photo to be used for marketing purposes at Nampa Christian Schools:

Yes   No

Emergency Contact Information

Please provide information for any persons authorized to pick up child and/or be contacted in case of emergency (other than parents)
First Emergency Contact
28.

Name:

29.

Relationship to Child:

30.

Telephone Number:

31.

Address:

Second Emergency Contact
32.

Name:

33.

Relationship to Child:

34.

Telephone Number:

35.

Address:

Medical Information
36.
* Has your child ever been identified as having any of the following? (1 required)
ADD/ADHD(Attention Deficit Disorder)   Behavioral Disorder
Learning Disorder   Mental Impairment
Emotional Impairment/Disturbance   Physical Impairment
Gifted/Talented   Speech/Language
None of the above
37.
*

Does your child have an IFSP?

Yes   No
38.

Child's Doctor:

39.

Doctor's Phone Number:

40.

Doctor's Address:

41.
*

I authorize the Nampa Christian Early Childhood Center to give my child Tylenol or Benadryl if needed:

Yes   No

Parent/Guardian Statement

The non-refundable application fee of $100 must be submitted with this application. Online payments can be made here.

42.
*

By Initialing below, I acknowledge that the above information is accurate and complete. I have read and understand the financial policies of the Early Childhood Center and agree to accept them.

Nampa Christian Schools admits students of any race, color, gender or ethnic origin to all the rights, programs and activities made available to students of the school. It does not discriminate on the basis of race, color gender, national or ethnic origin in the administration of its educational policies, admission policies, scholarships, athletics or any other school-administered programs. 

43.
* Has your child ever been identified as having any of the following?
Yes   No

* Email Address: