Admissions Form Pre-Kindergarten (4 year olds)

DAY Choice *M-F FULL DAY (Most Popular)M/W/F HALF DAYM/W/F FULL DAY

Child's Legal Name *

Nick Name

Child's Birth Date *

Child's Gender FemaleMale

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Guardian Email Address #1 *

Guardian Email Address #2

Mother's Name (Guardian #1)

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Father's Name (Guardian #2) *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Place of Employment (Mother) *

Place of Employment (Father) *

Parish

Does your child have any previous school experience? PLEASE LIST. *

How did you hear about ICA? *

Do you have any other children presently enrolled in Immaculate Conception Academy? *YesNo

Do you have any other children presently enrolled at another school? *YesNo

If you have another student at another school please list which school they attend.

Immaculate Conception Academy
903 Chestnut Street
Douglassville, PA 19518
Phone: 610-404-8645