PreSchool App (pending)

First United Methodist Church Pre-School Registration Application

Completing this form submits your information to our pre-school for registration only, Payment of the registration fees guarantees your child a place in our program.

* Indicates required field

Child's Name *

First

Last

Sex: *

Male Female

Name they prefer to be called *

Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address (if different) *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Phone Number *

Emergency Contact Info- Name *

First

Last

Emergency Contact Info - Phone Number *

Mother's Name *

First

Last

Occupation *

Work Phone Number *

Cell Phone Number *

Father's Name *

First

Last

Occupation *

Work Phone Number *

Cell Phone Number *

Marriage Status *

Child lives with: *

If other, please specify, *

Church Affiliation *

Physician *

Known Allergies *

Special Needs or Concerns *

Siblings Names & Ages: *

Please enroll my child in: *

2 year old 2 day/week Mon & Wed $80/month, $80 Reg Fee 2 year old 2 day/week Tues & Thurs $80/month, $80 Reg Fee 2 year old 4 day/ week $150/month, $100 Reg Fee 3 year old 3 day/week $100/month, $100 Reg Fee 4 year old 4 day/week $120/month, $120 Reg Fee Kindergarten 4 day/week $150/month, $150 Reg Fee

**Three and Four Year Olds must be potty trained

Safe Sanctuaries Fee: $50 (one time fee)
The General Conference of The United Methodist Church, in April 1996, adopted a resolution aimed at reducing the risk of child sexual abuse in the church. Thus, in covenant with all United Methodist congregations, we adopted this policy for the prevention of child abuse in our church. There are cameras in all preschool rooms that protect the child and the teacher.

**Please note: The Registration Fee guarantees your child a place in our program and is non-refundable. One-time fee of $50 for safe sanctuaries is due no later than June 30, 2016.

Once your form is submitted to our preschool, you must still pay your registration fee to hold your child's spot in our program.
Medical Release: If my child needs medical care while he/she is in your custody, by initialing below and electronically submitting my form, I authorize you to seek such medical care and to execute any documents required by a health care provider. I also understand that all attempts will be made to contact me if any injury results.

Electronic Signature accepting Medical Release. Please enter your full name below. *

Date *

Submit