Early Childhood Academy (Pre-K) Application

Knowledge Quest Early Childhood Academy Application

This application is for Knowledge Quest's full-day preschool program. Please fill out this application carefully and double check to ensure that all information provided is accurate and correct (including spelling).

Classroom:*

Afterschool Care*

Are you enrolling your child in our Extended Learning Academy? (3pm to 6pm)

Eligibility

Will the child be 12 months old on or before August 15, 2024?*

Will the child be 2 years of age on or before August 15, 2024?*

Will the child be 3 years of age on or before August 15, 2024?*

Will the child be 4 years of age on or before August 15, 2024?*

Uh Oh!

Based on their age, your child is not eligible for the class you've selected until next school year!

Parent or Guardian Information

Provide information for the primary caregiver for this child.

Guardian Name:*

First Last

Relationship:*

Is this person completing the form?*

Yes

No

Yes, with assistance.

If no, who is?

First Last

Guardian Address*

Same as child

Street Address Apartment # City State ZIP Code

Phone Number:*

Email:

Authorized Pick Up?*

Primary Contact?*

Legal Guardian?*

If no, who is the child's Legal Guardian?*

First Last

Parent Guardian Additional Information

Please provide demographic information about the parent/guardian listed above.

Relationship Status:*

Education Level:*

Employment Status:*

Full-Time

Part-Time

Unemployed

Not working

Employer Name:*

Job Title or Position:

Work Phone:

Work Address (Optional)

Street Address Address Line 2 City State ZIP Code

Add Parent/ Guardian?*

Parent/Guardian Information #2

Optional: contact information for a second parent or guardian.

Parent/Guardian Name:*

First Last

Relationship:*

Phone Number:*

Email:

Does this person live with child?*

Address*

Same as child

Street Address Apartment # City State ZIP Code

Authorized Pick Up?*

Education Level:*

Employment Status:*

Full-Time

Part-Time

Unemployed

Not working

Child Medical Information

It is the responsibility of the Parent or Guardian to provide Knowledge Quest with specific emergency procedures.

Are there any medical conditions or specifications?*

Including allergies, medical issues, food requirements, etc.

Yes

No

If yes, list conditions/concerns. Add a new row for each.

Does participant have a regular Primary Physician/Pediatrician?*

Yes

Yes, but I cannot provide contact information at this time

No, there is no pediatrician or primary physician

Name of Physician:*

Prefix First Last

Physician Phone:*

Insurance Name:

Policy #:

Hospital Affiliation:

Dismissal Information

What is the child's mode of transportation?*

Pick Up by designated party

Released to KQ ELA (Afterschool)

Stay Tuned for more information

Please be on the lookout for communication from our Extended Learning Academy staff regarding program expectations.

List those Authorized for Pick Up (add row for each):*

First Name

Last Name

Phone

Relationship

Emergency Contacts

Please provide contact information for at least one additional adult (other than parent/guardians listed above) to contact in case of emergency. Add additional lines for each contact you wish to add.

Additional Emergency Contact(s):*

First Name

Last Name

Phone

Relationship

Add row for each

Consents & Authorization

Please read the statements below carefully.

Knowledge Quest History

Please provide details about the child and the child's family's previous experiences with KQ programming.

Knowledge Quest Member*

Does your family already have a Family Coach through our Family Stability Center?

Who is your Family Coach?*

Fill our your intake form to be assigned a Family Coach

Please register for a Family Coach on our website if you do not currently have one! https://s1k.4b6.myftpupload.com/programs/family-stability-initiative/register/

Early Childhood Academy (Pre-K) Application

Early Childhood Academy (Pre-K) Application

Early Childhood Academy Application 2024-2025 (Updated)

Knowledge Quest Early Childhood Academy Application

Eligibility

Uh Oh!

Child's Information

Parent or Guardian Information

Parent Guardian Additional Information

Parent/Guardian Information #2

Household Information

Child Medical Information

Dismissal Information

Stay Tuned for more information

Emergency Contacts

Consents & Authorization

Knowledge Quest History

Fill our your intake form to be assigned a Family Coach

Thank you for being a Knowledge Quest member!

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Main Campus