Renaissance School
              867 North Pleasant Street, Amherst, Ma
                  Application for Enrollment

Date of Application ________________________

Child’s Name __________________________________ Male or Female (circle one)

Date of Birth ____________________________Telephone _______________________

Address ___________________________________________________________________

Parent/Guardian _________________________ Telephone _______________________

Parent’s Address __________________________________________________________

Parent’s Occupation ____________________________Email _____________________

Parent/Guardian_________________________ Telephone ________________________

Parent’s Address __________________________________________________________

Parent’s Occupation ____________________________Email _____________________

What is the native language spoken in your child’s home? __________________

If it is other than English, does your child speak/understand English? ____

Has your child attended preschool before? (please list organized experiences 

with other children such as Storytime at library, family day care, etc.) 

___________________________________________________________________________

When would you like your child to start in our program?______________ How do 

you think your child will separate from you at preschool?__________________

___________________________________________________________________________

Please mention your reasons for sending your child to our program _________

___________________________________________________________________________

Tell us about your child…. what are his/her strengths, interests? _________

___________________________________________________________________________

___________________________________________________________________________

Does your child have any special needs we should be aware of? _____________

___________________________________________________________________________

How did you hear about our program? _______________________________________

*To complete the application process, please include a deposit of $100.00 
with this application. Checks should be made payable to “Renaissance School.”  
Thank you.       Office Use Only:  Date Deposit Received______ Accepted?___ 
Child’s age at admission _____