Pre-K Application – Hanover Academy

Applicant Information

First Name

Middle Name

Last Name

Nickname

Gender

Age

Date of Birth

Home & Day Care Addresses

Address

City

State/Province

Zip/Postal

Home Phone #

Current Day Care Provider

Name

Day Care Address

City

State/Province

Zip/Postal

Parent / Guardian Information

Father's Name

First

Last

Employer

Position Title

Business Phone

Business Address

City

State/Province

Zip/Postal

Parent / Guardian Information

Mother's Name

First

Last

Employer

Position Title

Business Phone

Business Address

City

State/Province

Zip/Postal

If Applicable:

Are Parents Separated?

Yes

No

Divorced?

Yes

No

With whom does the applicant live?

Who is responsible for finances?

Address (If different from above)

City

State/Province

Zip/Postal

Number of brothers

Ages

School(s)

Number of sisters

Ages

School(s)

Does your child have any physical condition which would restrict his/her activities?

How did you hear about Hanover Academy?

Referred by:

Father's Email Address

Personal

Father's Email Address

Work

Mother's Email Address

Personal

Mother's Email Address

Work

Signature

Clear

Hanover Academy admits students without regard to sex, race, color, religious, national or ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate in the administration of its education policies, admissions policies, financial aid grants, athletics, or other school administration programs.