Procare

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Epworth Preschool

3002 Hope Valley Road, Durham, NC, 27707

Student #1

First Name

Last Name

Date of Birth

Allergies

Medical Conditions

Required Medications (Epi Pen, etc.)

Will your child be able to participate in all phases of school activity? If not, please explain.

Has your child ever been referred or evaluated for developmental or speech delays, behavioral, or other needs? If yes, please indicate when and where.

Is there any other information you would like to share about your child that might help us with class placement?

Have you previously applied to Epworth Preschool for this child?

Is the applicant currently enrolled, or have they been enrolled previously, in another preschool? If yes, please list the name of the school & years attended.

We use August 31st as our cutoff date for class placement. Please select your child's age on 8/31/25.

Your Child's Gender

#1 Class Preference

#2 Class Preference

#3 Class Preference

Is this applicant a child or sibling of a previously enrolled Epworth student? If yes, please provide details.