2008-2009

Student Application Form

Please check all that apply:

__________ St. James’ Episcopal Church Active Member or St Gabriel’s Active Member

Membership at St. James’ Episcopal Church is defined as those who actively and regularly participate in the worship, Mission, Ministry, and educational offerings of St. James’ Church, and who support St. James’ through regular contributions on a written financial pledge. St Gabriel’s members: Please attach a letter from Pastor Jeunee Cunningham for membership verification purposes with this application.

__________ 2008-2009 Returning Student* __________ Attend St. James’ Sunday School

__________ 2008-2009 Returning Student Sibling __________ Alumni Sibling

__________ 2008-2009 Graduating Student Sibling __________ Community Member

*Previous year’s (2007/08) Class/Teacher __________________________________________

Please return this form with your non-refundable $100.00 application fee (made payable to St. James’ Preschool)

to St. James’ Preschool, 14 Cornwall Street NW, Leesburg VA 20176.

Child’ Last Name: Child’s First Name: Child’s Middle Name

Name to be called: _____________________________________________________________________

Age as of 9/30/09: _____________ Birthdate: ____________________ Gender: __________________

Address:______________________________________________________________________________

City: ___________________________________ Zip: _________________________________________

Subdivision: _____________________________ Home Phone: _________________________________

Mother’s Full Name: ______________________ Father’s Full Name: _____________________________

Mother’s Work Phone: ____________________ Father’s Work Phone: __________________________

Mother’s Cell Phone: _____________________ Father’s Cell Phone: ____________________________

Other siblings currently seeking enrollment: ________________________________________________

Submission of this application does not guarantee enrollment. A random “Lottery-type” system will be used if more requests are made then spaces available in a class. See class schedule on previous page. Add additional comments

on backside. Please indicate your first and second choice below:

	Class Number	Age	Days of the Week	Time
First Choice
Second Choice

FOR OFFICE USE ONLY:

Application fee paid: _____ Check # ______ Acceptance Sent: ______

Check returned _____ Wait Listed ______ Letter Sent _____

Notes regarding application: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________