PreK Application for Lottery Application for ELC at Kaune Early Learning Center at Kaune I am applying for School Year:* 2020-2021 2021-2022 Child's Name* First Last Child's Date of Birth* Gender* Primary language spoken at home:* Additional languages spoken in the home: 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 I am applying for (Please check all that apply):* Full day/ School year: Monday - Friday 7:30 a.m. until 5:30 p.m. (August through May) Core Hours only: Monday - Thursday 9:00 a.m. until 3:00 p.m. and Friday 9:00 a.m. until 1:00 p.m. (August through May) June and July - Full Day: 7:30 a.m. until 5:30 p.m. June and July - Core Hours: Monday - Thursday 9:00 a.m. until 3:00 p.m. and Friday 9:00 a.m. until 1:00 p.m. Payment OptionsECECD Childcare Assistance is accepted! Other financial assistance may be available if there is a demonstrated need. A member of the Kaune office team will contact you upon receipt of your application to confirm placement on our lottery/wait list. They will be available to discuss all payment options at that time. Parent/ Guardian Name* First Last Parent/ Guardian Date of Birth* MM slash DD slash YYYY Parent/ Guardian Phone*Parent/ Guardian Email* Parent/ Guardian Name First Last Parent/ Guardian Date of Birth MM slash DD slash YYYY Parent/ Guardian PhoneParent/ Guardian Email Alternate Contact Name* First Last Phone*Relationship to the Child* Have you had any other children attend PreK at the Early Learning Center at Kaune, Aspen or Ramirez Thomas?* Yes No If yes, what was the name of the participant? When did this participant begin the program? MM slash DD slash YYYY When did this participant end the program? Has this child participated in any of the following programs our organization offers? Family, Friends & Neighbors First Born® HiddenIf yes, what was the name of the participant? When did this child begin the program? When did this child end the program? At age 3, did your child attend another Early Childhood Program?* Yes No HiddenIf yes, where and for how long?Does your child have an Individual Education Plan (IEP) or Individualized Family Service Plan (IFSP)?* Yes No If yes, what services/accomodations does your child receive?