Balanced Beginnings Preschool is offered in two locations at Balance Autism: Clive and Quad Cities. Please fill out the application for either locations below. A representative from Balance Autism will contact you within 48 hours of submission.

APPLICATION FOR PRESCHOOL

Child First Name

Child Last Name

Address

City

Address Line 2

State

Zip Code

Date of Birth

Location Preference

How soon do you hope to enroll your child in Balanced Beginnings Preschool?

TELL US MORE

I confirm my child

Communicates vocally

Is toilet-trained

Interested in peers

My child communicates by

My child's strength's are

Difficulties for my child include

The level of support my child needs to separate from me is

Other group, structured experiences my child has had include (preschool, Sunday School, dance, gymnastics, etc)

I hope my child receives the following out of this experience

I understand

My submitted application does not guarantee admission to the program.

Please contact me about the possible volunteer opportunities in or for the preschool.

Yes, I'm interested.

No, I'm not interested or unable.

Submitted by

Parent Email

Parent Primary Phone Number