<p> Peoria Christian Preschool North Application Located at Grace Presbyterian Church, 8607 N. State Rt. 91, Peoria, IL 61615</p><p>Call (309) 686-4500 ext. 17 or email [email protected] with questions</p><p>Mail completed application to Peoria Christian Preschool North Admissions, 3506 N. California Ave., Peoria, IL 61603</p><p>Today’s Date______Application Fee Check #______(application fee is $55.00 for PCS Pre-K North, include check with application to hold a program spot) Please mark requested program:</p><p>____ 3-year-old Pre-K 2-day a.m. (Mon. and Wed. - Class times are from 8:45 a.m. – 11:30 a.m.) ____ 4-year-old Pre-K 3-day a.m. (Mon., Wed., Fri. – Class times are from 8:45 a.m. – 11:30 a.m.)</p><p>Student Name______Gender______Last First Middle By what name does your child prefer to be called?______Birthdate:______</p><p>Home Address:______City______State____Zip______</p><p>Home Phone:______Email address:______</p><p>Student Resides with: __Both Parents __ Father __ Mother__ Other (list): ______</p><p>Marital Status: __Married__Unmarried__Separated__Divorced__Remarried__Widowed</p><p>Father’s Name: ______Mother’s Name______</p><p>Place of Employment______Place of Employment______</p><p>Work/Cell Phone______Ext.___ Work/Cell Phone______Ext.___</p><p>Who will be responsible for making tuition payments (ie: grandparents – list name and phone number if other than parents) ______</p><p>Church (if you currently have one) ______</p><p>Emergency Contact Name (other than parents)______Phone______</p><p>Please complete both sides of this application Page 2 of 2</p><p>Peoria Christian Preschool North Application Located at Grace Presbyterian Church, 8607 N. State Rt. 91, Peoria, IL 61615</p><p>Special Medical Information (use separate sheet if necessary and attach)</p><p>List allergies:______</p><p>Does your child have any physical disabilities? Yes No If yes, please explain:______</p><p>Does your child have any behavioral difficulties? Yes No If yes, please explain: ______</p><p>Is this child under the supervision of the Department of Children and Family Service (DCFS)? Yes No</p><p>From the Peoria Christian School Constitution: The authority for the constitution of this association is the Holy Scripture and its teaching as understood in the literal, grammatical and cultural sense and shall be binding on this association as long as it exists. Every statement, regulation and provision of the constitution and by-laws of this association must be in harmony with and applied in harmony with the relevant teaching of the Scriptures. No statement, policy or action shall be taken that infringes upon or contradicts the teaching of the Scriptures as interpreted by the following doctrinal statement: Peoria Christian School Statement of Faith We believe the Scriptures of the Old and New Testaments are inspired by God, and are inerrant in the original writings, and that they are of supreme and final authority in faith and life. We believe in one God, eternally existent in three persons: Father, Son and Holy Spirit. We believe in the deity of our Lord Jesus Christ, in His virgin birth and His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His future, personal return in power and glory. We believe that for the salvation of the lost and sinful man, regeneration by the Holy Spirit is absolutely essential. We believe in the resurrection of both the saved and the lost: they that are saved unto the resurrection of life, and they that are lost unto the resurrection of damnation. We believe in the spiritual unity of all believers in our Lord Jesus Christ.</p><p>I have read the Statements of Faith, above, and recognize that these principles will be taught at Peoria Christian Preschool North. </p><p>Parent Signature______Date______</p><p>Mail or drop off completed application with application fee to: Peoria Christian School Attention: Preschool North Admissions 3506 N. California Ave Peoria, IL 61603</p>