Home
About Us
Our Program
- Our Curriculum
For Parents
Employment
Contact Us
- Preschool Application
- Elementary Application

Home
About Us
Our Program
- Our Curriculum
For Parents
Employment
Contact Us
- Preschool Application
- Elementary Application

Preschool Application

Preschool ApplicationLighthouse Daycare2022-05-09T16:07:21+00:00

Our center is licensed to care for children between the ages of six weeks and twelve years old. We do not discriminate against children on the basis of race, color, gender, or national origin. Please provide the following information about your child.

Go to Elementary Application

Child's Name *

Child's Date of Birth *

Gender

Male

Female

Tell us about your child's personality *

Parent/Guardian Information

Main Email Address for Parents/Guardian

Does this child live at more than one address weekly? (For example: Shared Custody) *

Yes

Parent/Guardian #1

Parent or Guardian #1's Name *

Phone Number *

Relationship to Child *

Parent/Guardian #2

Parent or Guardian #2's Name *

Phone Number *

Relationship to Child *

About Your Child

Is your child potty trained? (for 2 years and older) *

Yes

Does your child have siblings who attend one of our Centers currently or in the past? *

Yes

If yes, please list their names.

What date are you looking for care to begin? *

Has your child been enrolled in a daycare before? *

Yes

To better serve your child and your family needs, please list any disabilities or referrals from your pediatrician has made for your child.

Has your child received services through the Birth to Three Program?

Yes

If yes, please check the services your child has received.

Occupational Therpy

Speech Therapy

Dietary

Physical Therapy

Other

Please list any other services received

Has your child received services from a mental health professional?

Yes

Does your family qualify for assistance with tuition through Connect or Link Resources and Referral? *

Yes

Not Sure

If unsure, please contact Link (Putnam County) at 304 523-9540.

Has your child been enrolled in a daycare before? *

Yes

If yes, please list each center and the reason for leaving each one.

Please list any food allergies your child has.

Please list any environmental allergies your child has.

Does your child require an EpiPen?

Yes

Thank you for your interest in Lighthouse. One of our staff members will be in touch as soon as possible regarding your application.

There was an error trying to send your message. Please try again later.

Lighthouse Christian Academy
and Daycare Center

2440 Route 60
Hurricane, WV

304 562-3900

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