Peer Program Enrollment

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****The preschool peer spots for the 23/24 school year are currently full. Please fill out the following form to be placed on the waitlist.****

By completing this form, you are expressing an interest in having your son/daughter participate in the Big Walnut Preschool Program as a Peer Model. The Big Walnut Preschool Program is a special needs preschool geared at strengthening the skills of students with disabilities with an added benefit of preparing all students for kindergarten.

If you have concerns about your child's development, your child's behavior, or if a teacher, therapist, or medical professional has expressed concerns about your child, DO NOT complete this enrollment request form. Instead, email amykeep@bwls.net to share your concerns to see how we can best support your child's needs.

The peer program is designed for students who are 4 years old prior to August 1st with the intention of registering for kindergarten the following school year. Peers serve as models of age-appropriate skills for children demonstrating delays in their development.

Email *

Child's Name *

Child's Birthdate *

YYYY

Your child must be 4 by August 1, 2023. How old will your child be on August 1, 2023? *

Parent name and phone number *

Parent email address to send verification *

If the district is able to provide transportation to peers, please list the address the student resides or will need to be transported to/from (note we do not transport from day cares, only residences).

*Please note if your child will be a car rider.

*Class assignments for AM or PM will be determined by residence or location for pick up/drop off.

The cost of our 4-day peer model program is $200/month.
*

Yes, I agree to pay the $200/month tuition fee by the 1st of the month. To hold a spot in the program we require the last month tuition at time of registration.

I would like information about free/reduced tuition based on household income.

Other:

Is your child completely toilet trained? (wears underwear and not pull-ups, verbalizes to adult when they need to use the restroom, able to wipe after bowel movement independently, has not had an "accident" in the past 2 months)
*

Yes

Other:

Does your child separate easily form parent/main caregiver?
*

Yes

Other:

Does your child speak in clear sentences? Is your child's speech clear and understandable by unfamiliar adults?
*

Yes

Other:

Does your child talk to other children while playing?
*

Yes

Other:

Does your child demonstrate an ability to use crayons, scissors and glue to complete a project?

Yes

Other:

Clear selection

Is your child well-coordinated and able to walk, run, jump and climb?
*

Yes

Other:

Thank YOU!

The peer spots for the 23/24 school year are currently full. Filling out this form will place you on the waitlist.

A copy of your responses will be emailed to the address you provided.

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