PIPER EMPLOYEE PRESCHOOL APPLICATION Entering Year* 2021-2022 2022-2023 2023-2024 or later. I'm a planner. Campus* Santa Monica Los Angeles Dealer's Choice Child's First Name* Child's Last Name* Child's Date of Birth* MM slash DD slash YYYY Child's Gender* Male Female Applying for twins?*Other than twins, if you are applying for multiple children, each will need to have their own separate application. No Yes Second Child's First Name* Second Child's Last Name* Second Child's Gender Male Female Program*Please select the age range for which your child will be by September 1st. Don't be sneaky. Preschool (2.0-4.2) Pre-K (4.0-Kindergarten Entry) What type of education are you considering for Kindergarten?* Public Private Not Sure Private school applicant information:* We will be a new family applying to schools. My child has sibling status. Our family has alumni status. We are currently affiliated with the following school:* How did you hear about Piper?* Were you referred?* Yes No Who referred you?* Do you have a current affiliation with Piper?Check all that apply. Yes, sibling attending Piper Preschool. Yes, child attending Parenting Program. Yes, child attending Enrichment Class(es). Yes, friends of current Piper family. Newbie... can't wait to meet everyone. Parent A First Name* Parent A Last Name* Parent A Phone*Parent A Email* Enter Email Once more for the people in the back. Parent A Occupation* Parent A Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is there another parent in the picture?* Yes No Parent B First Name* Parent B Last Name* Parent B Phone*Parent B Email* Enter Email Come again? Parent B Occupation* Parent B Address (if different from Parent A) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Siblings?* Yes No Sibling's Name Sibling's Date of Birth MM slash DD slash YYYY School Attending More Siblings?* Yes No Sibling's Name Sibling's Date of Birth MM slash DD slash YYYY School Attending Sibling's Name Sibling's Date of Birth MM slash DD slash YYYY School Attending Family Status* Married Partners Divorced Courting It's Complicated Unfriended I'm Not Sure Where They Are Anymore Child's Primary Residence* Parent A & B Parent A Parent B Guardian They Have Their Own Place In Venice Is your child potty trained?* Yes No Kinda Is the second child potty trained?* Yes No Kinda Does your child have any special health concerns?* Yes No Special Health Concerns* Does the second child have any special health concerns?* Yes No Second Child Special Health Concerns* Does your child have any special needs?* Yes No Special Needs* Does the second child have any special needs?* Yes No Second Child Special Needs* Is your child receiving any services (OT, Speech, etc.) or have they in the past?* Yes No Is your second child receiving any services (OT, Speech, etc.)?* Yes No Has your child spent any time away from you?* Yes No How'd they do?* Nailed it. Shed a tear or two. No comment. Has your second child spent any time away from you?* Yes No How'd the second child do?* Nailed it. Shed a tear or two. No comment. How do think you will handle separation?* High-Five Moonwalk out while smiling. Lurk Helicopter Cry Profusely Who best describes your child?* Mitch Hedberg Julio Iglesias Betty White Barack Obama Marie Curie Beyonce Who best describes your second child?* Mitch Hedberg Julio Iglesias Betty White Barack Obama Marie Curie Ellen Degeneres Beyonce Rate Your Crazy* 1) Not at all. 2) Who me? Not at all. 3) I'm pretty easy going. 4) I have my days. 5) Some might say that I have my days. 6) I collect stuffed animals. 7) I have more than 3 cats. 8) Why are you asking? Did you talk to someone? 9) No really, did you talk to someone? Just tell me their name. Who was it?! 10) I don't have children. You got front row sold-out tickets for Bon Jovi... new sitter... your child begins a quick dramatic spiral. You are more likely to:* Kiss your finger, touch their forehead, and dash. "Living on a Prayer" is only great live. Explain that we really need this night together because Jon's smile gives Mommy chills. Tuck them in, then leave. Start crying, apologize for thinking of going, and let them sleep in your bed. Wait. Who's Bon Jovi? If you’re offered a spot at Piper but the schedule isn’t what you prefer, you are more likely to:* Hey man… pfffft, no worries. I'm just happy to be here. Gladly accept, but request to be put on your waitlist. I know it's nothing personal. Internalize, then call my BFF and cry about how the world is always against me. Politely decline. I just can't make it work... pinky swear. Briefly describe what's in front of you right now.*How would you like to be involved in the Piper Preschool Community?*Anything else you'd like us to know?Upload A Family Photo*Max. file size: 3 MB. Email*
