On-line Application Form St John's Nursery School Application Form Which program are you applying for:*2's Program3's Program4's ProgramWhich school year are you applying for?Parishioner*YesNoSibling of former or current pupil*Sibling of former pupilSibling of current pupilNeitherChild's full name First Last Child's nicknameGenderMaleFemaleChild's birthdateParent's name First Last Parent's name First Last Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home phoneParent cell phoneParent cell phoneEmail 2's Program:There are two different options for the 2's program. We will try to place your child in your first choice. If space is not available, we will assign your child to the available option, unless you indicate that you do not want us to.Please check your first choice. 3 mornings - Mon/Wed/Fri (9:00-11:30 a.m.) 2 mornings - Tues/Thurs (9:00-11:30 a.m.) 3's Program:There are four different options for the 3's program. Please let us know your order of preference. We will try to place you in your top choice, but may not be able to do so because of limited space. Thanks for understanding.Please check your first choice: 3 mornings - Mon/Wed/Fri (9:00-11:30 a.m.) 3 mornings - Tues/Thurs/Fri (9:00-11:30 a.m.) 5 mornings - Mon-Fri (9:00-11:30 a.m.) 3 afternoons - Mon/Wed/Fri (12:45-3:15 p.m.) Please check your second choice: 3 mornings - Mon/Wed/Fri (9:00-11:30 a.m.) 3 mornings - Tues/Thurs/Fri (9:00-11:30 a.m.) 5 mornings - Mon-Fri (9:00-11:30 a.m.) 3 afternoons - Mon/Wed/Fri (12:45-3:15 p.m.) Please check your third choice: 3 mornings - Mon/Wed/Fri (9:00-11:30 a.m.) 3 mornings - Tues/Thurs/Fri (9:00-11:30 a.m.) 5 mornings - Mon-Fri (9:00-11:30 a.m.) 3 afternoons - Mon/Wed/Fri (12:45-3:15 p.m.) Please check your fourth choice: 3 mornings - Mon/Wed/Fri (9:00-11:30 a.m.) 3 mornings - Tues/Thurs/Fri (9:00-11:30 a.m.) 5 mornings - Mon-Fri (9:00-11:30 a.m.) 3 afternoons - Mon/Wed/Fri (12:45-3:15 p.m.) 4's ProgramThere are two options for the 4's program. We will try to place your child in your first choice. If space is not available, we will assign your child to the available option, unless you indicate that you do not want us to.Please check your first choice: 5 mornings - Mon-Fri (9:00-11:30 a.m.) 5 afternoons - Mon-Fri (12:45-3:15 p.m.) Payment and Other InformationOther informationDoes your child have any physical or emotional disabilities which might affect his/her normal participation in class? If so, please describe above.Signature of parentIt is understood that this application is not binding upon the school or the applicant. Letters of acceptance will be mailed out on December 15. Ten openings in each of the two year old sections will be filled by receipt of applications in the following order: children with siblings currently enrolled, children of parishioners in good standing (which means regular attendance and regular contributions of support), siblings of former students, and new applicants. Sixteen openings in each of the three year old sections and eighteen in the four year old sections will be filled by receipt of applications in the following order: children attending the 2's or 3's program during the previous year, children of parishioners in good standing (which means regular attendance and regular contributions of support), siblings of former students, and new applicants. Priority will be given to parishioners and siblings until November 30 of the preceding year. A non-refundable deposit will be required, which will be applied to the first term's tuition.Application Fee*The application fee is $75. You may pay online, using PayPal, or by check. Please indicate how you would like to pay. We will not be able to process your application until your fee has been received. Thank you.Will pay online using PayPalWill pay by check: make check payable to St. John's Nursery School and mail to 4 Fountain Square, Larchmont, NY 10538Fee not required at this time per director (no openings)IF PAYING BY PAYPAL, Name of Person Making Payment: First Last Email Address of Person Making Payment Enter Email Confirm Email Application Fee Price: $75.00 Date Date Format: MM slash DD slash YYYY