Whitehouse Preparatory School » Admissions Application

Please complete the application below.

Student Information
Student Name
First Middle Initial Last
Preferred Name
Home Address
Street Address City State / Province ZIP Code
Student's Date of Birth*
Home Phone*
Preschool Information
Present Preschool
Date Started
MM slash DD slash YYYY
Date Completed
MM slash DD slash YYYY
School's Phone Number
Family Information
Father's Name*
Address if different than student
Street Address City State / Province ZIP Code
Cell Phone*
Work Phone
Email*
Employer
Occupation/Position
Mothers's Name*
Address if different than student
Street Address City State State / Province
Cell Phone*
Work Phone
Email*
Employer
Occupation/Position
Brother(s) and sister(s) of the Student
Name
DOB
MM slash DD slash YYYY
School Attending if any
Program Interested In Preschool or Jr. K?
Full Day or Half Day
3, 4 or 5 Days
Paternal Grandparents Name(s)
Paternal Grandparents Address
Street Address City State / Province ZIP Code
Maternal Grandparents Name(s)
Maternal Grandparents Address
Street Address City State / Province ZIP Code
Do you think the grandparents would be interested in participating in Whitehouse Prep’s Intergenerational Program?:
- Yes
- No
General Information
How did you learn about Whitehouse Prep?
Will your child need before care?
- Yes
- No
Will your child need after care?
- Yes
- No
If so, what is the expected time range?
If you or any member of your family has any special talents that you would be willing to share with our students (for instance gardening, painting, an interesting hobby and the like, please explain:
Does your child require any type of accommodation based on his or her health or physical condition?
- Yes
- No
If you answered "yes" to the question above, please explain:
Parental Signatures
I/We affirm that the information provided in this application is true and accurate to the best of my/our knowledge and I also grant you permission to screen my child.
Signature of Parent/Guardian
Date
MM slash DD slash YYYY
Signature of Parent/Guardian
Date
MM slash DD slash YYYY
A registration fee of $125 is required at the time the application is submitted. Kindly make check payable to Whitehouse Preparatory School. The completed application and fee should be delivered to the school either in person or by mail. The $125 fee is nonrefundable.
Nondiscrimination Policy: Whitehouse Preparatory School admits students of any race, color, creed, national and ethnic origin, gender or physical disability to all the rights, privileges, programs and activities generally accorded or made available to students at the School to the extent required by law. The School does not discriminate on the basis of race, creed, gender, color, sexual orientation, physical disability, or national or ethnic origin in the administration of its educational, admissions and financial aid policies and programs.

Admissions Application

Please complete the application below.

Student Information

Preschool Information

Family Information

Brother(s) and sister(s) of the Student

General Information

Parental Signatures