Application – Piper SM

Entering Year*

2019-2020
2020-2021
2021-2022 or later. I'm a planner.

Campus*

Santa Monica
Los Angeles
Dealer's Choice

Child's First Name*

Child's Last Name*

Child's Date of Birth*

Child's Gender*

Male
Female

Applying for twins?*

Other than twins, if you are applying for multiple children, each will need to have their own separate application.

No
Yes

Second Child's First Name*

Second Child's Last Name*

Second Child's Gender

Male
Female

Program*

Please select the age range for which your child will be by September 1st. Don't be sneaky.

Preschool (2.0-4.2)
Pre-K (4.0-Kindergarten Entry)

What type of education are you considering for Kindergarten?*

Public
Private
Not Sure

Private school applicant information:*

We will be a new family applying to schools.
My child has sibling status.
Our family has alumni status.

We are currently affiliated with the following school:*

How did you hear about Piper?*

Were you referred?*

Yes
No

Who referred you?*

Do you have a current affiliation with Piper?

Check all that apply.

Yes, sibling attending Piper Preschool.
Yes, child attending Parenting Program.
Yes, child attending Enrichment Class(es).
Yes, friends of current Piper family.
Newbie... can't wait to meet everyone.

Parent A First Name*

Parent A Last Name*

Parent A Phone*

Parent A Email*

Enter Email Once more for the people in the back.

Parent A Occupation*

Parent A Address*

Street Address Address Line 2 City State ZIP Code

Is there another parent in the picture?*

Yes
No

Parent B First Name*

Parent B Last Name*

Parent B Phone*

Parent B Email*

Enter Email Come again?

Parent B Occupation*

Parent B Address (if different from Parent A)

Street Address Address Line 2 City State ZIP Code

Siblings?*

Yes
No

Sibling's Name

Sibling's Date of Birth

School Attending

More Siblings?*

Yes
No

Sibling's Name

Sibling's Date of Birth

School Attending

Sibling's Name

Sibling's Date of Birth

School Attending

Family Status*

Married
Partners
Divorced
Courting
It's Complicated
Unfriended
I'm Not Sure Where They Are Anymore

Child's Primary Residence*

Parent A & B
Parent A
Parent B
Guardian
They Have Their Own Place In Venice

Is your child potty trained?*

Yes
No
Kinda

Is the second child potty trained?*

Yes
No
Kinda

Does your child have any special health concerns?*

Yes
No

Special Health Concerns*

Does the second child have any special health concerns?*

Yes
No

Second Child Special Health Concerns*

Does your child have any special needs?*

Yes
No

Special Needs*

Does the second child have any special needs?*

Yes
No

Second Child Special Needs*

Is your child receiving any services (OT, Speech, etc.) or have they in the past?*

Yes
No

Is your second child receiving any services (OT, Speech, etc.)?*

Yes
No

Has your child spent any time away from you?*

Yes
No

How'd they do?*

Nailed it.
Shed a tear or two.
No comment.

Has your second child spent any time away from you?*

Yes
No

How'd the second child do?*

Nailed it.
Shed a tear or two.
No comment.

How do you think you will handle separation?*

High-Five
Moonwalk out while smiling.
Lurk
Helicopter
Cry Profusely

Who best describes your child?*

Who best describes your second child?*

Rate Your Crazy*

You got front row sold-out tickets for Bon Jovi... new sitter... your child begins a quick dramatic spiral. You are more likely to:*

Kiss your finger, touch their forehead, and dash. "Living on a Prayer" is only great live.
Explain that we really need this night together because Jon's smile gives Mommy chills. Tuck them in, then leave.
Start crying, apologize for thinking of going, and let them sleep in your bed.
Wait. Who's Bon Jovi?

If you’re offered a spot at Piper but the schedule isn’t what you prefer, you are more likely to:*

Hey man… pfffft, no worries. I'm just happy to be here.
Gladly accept, but request to be put on your waitlist. I know it's nothing personal.
Internalize, then call my BFF and cry about how the world is always against me.
Politely decline. I just can't make it work... pinky swear.

Briefly describe what's in front of you right now.*

How would you like to be involved in the Piper Preschool Community?*

Anything else you'd like us to know?

Upload A Family Photo*

Max. file size: 3 MB.

Preschool Application Fee

Price:

Preschool Application Fee for Twins

Price:

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

PRESCHOOL APPLICATION