Northwest High School
13501 Richter Farm Road
Germantown, Maryland 20874
Fax: 301-601-4662
Phone: 301-601-4660
NORTHWEST JUNIOR JAGUAR PRESCHOOL APPLICATION
Please PRINT all of the following information clearly.
Child’s Name: _________________________________________________________________
Last
Name
Middle
Prefers to be called: ________________________________
Sex: Male /
Female (Circle one)
Birth date: _____________________________
Age ______ Years
_______ Months
Address: ______________________________________________________________________
Street
City
State
Zip
Phone: ___________________________________ E-mail: _____________________________
Siblings Names
_______________________________
_______________________________
_______________________________
_______________________________
Age
________
________
________
________
Father’s Name: ___________________________ Occupation____________________________
Mother’s Name: ___________________________Occupation ___________________________
The child currently lives with: (both parents, Mom, Dad, other): __________________________
Family Ethnic or Cultural Background ______________________________________________
Language Spoken at home________________________________________________________
Food Allergies ____________________________ Dietary Restrictions_____________________
Pervious School Experiences: _____________________________________________________
Parent Contact:
Father’s Home_____________________ Work__________________ Cell__________________
Mother’s Home____________________ Work__________________ Cell__________________
Emergency Contact (if parents are not available)
Name: ___________________Relationship to Child:_______________Number:_____________
Doctor’s Name: __________________________________ Phone: ________________________
Hospital Preference: _____________________________________________________________
Fall Holidays Celebrated:_________________________________________________________
Winter Holidays Celebrated: ______________________________________________________
Spring Holidays Celebrated:_______________________________________________________
Thank you for completing our Junior Jaguars Preschool Application. Your child will receive the
best education Northwest Students have to offer.
Please mail your application to:
Northwest High School
Child Development Program
13501 Richter Farm Road
Germantown, Md. 20874
You may also drop off the application at the school during normal school hours between
7:30am- 3:30pm.
Signature: ___________________________________________ Date: ____________________