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Northshore Tuition Application
Please complete and submit this form. Our Early Childhood team will review your application and reach out with next steps. * No Kindergarten eligible students will be accepted.
Child(s) Name:
*
First Name
Last Name
Birth Date:
*
-
Month
-
Day
Year
Date
Gender
*
Parent/Guardian Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Parent/Guardian Name:
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Year:
*
2025-26
2026-27
Session Preference
*
AM (8.15 - 10.45)
PM (12.00 - 2.30)
No Preference
Child Information
Do you suspect your child has a developmental delay or disability?
*
Social Emotional
Motor
Communication
Cognitive
Adaptive/Self Help
No Concerns
If yes, please describe:
Does your child have an Individual Education Plan(IEP) or have they received B-3 Early Intervention Services(IFSP)?
*
Yes
No
If yes, please attach a copy of the IFSP or IEP here:
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Drag and drop files here
Choose a file
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Do you have concerns about your child's health and development? Check all that apply:
*
Low birth weight(less than 5.8lbs)
Fine motor/gross motor
Speech/language
Vision
Tooth pain/decay/bleeding gums
Drug/alcohol affected
Any Allergies
Food intolerance
Mental Health
Behavior
None
Please describe the concerns:
Has your child had previous preschool experience?
*
Yes
No
Can your child sit and attend to a story or activity for 10 minutes?
*
Yes
No
Can your child follow simple adult directions independently?
*
Yes
No
Does your child play with other children?
*
Yes
No
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How does your child get along with other children?
*
How does your child react when it is time to stop an activity and when there is change in routine or when they are told "no"?
*
Describe how your child handles frustration.
*
What kind of small motor activities (coloring, cutting, using playdough) is your child able to do?
*
Is your child able to use playground equipment (swings, slides, climbing toys) independently?
*
Yes
No
What is the primary language spoken in your home?
*
On average, how many words does your child use in a sentence?
*
Across all of his/her languages, does your child use at least 400 vocabulary words?
*
Yes
No
Does your child say most sounds except perhaps R, S, TH and L?
*
Yes
No
Any additional information you think we should know?
How did you hear about our program?
Are you current/past parent or NSD employee?
Please Explain
I understand that,
*
I am responsible for transportation to and from school.
My child must be fully potty trained to attend this program.
Signature
Date
-
Month
-
Day
Year
Date
Submit
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