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June 2015 rev. REGISTRATION FORM 2015‐2016 Date Received By Preschool: ____________________ Ages: 3 Year Olds through 5 Year Olds A non‐refundable Registration Fee of $50 is due with this Registration. Registration Fee of $30 for each additional child (non‐
refundable). The Application, Medical Form, and Orientation information will be mailed to you in July. The Supply Fee and September Tuition are due in late July with the Application. April Tuition is due in August at Orientation. CUMC Preschool admits students of any race, color, and national or ethnic origin. If you have any questions, please call the Preschool Director at (317) 867‐0582. ALL CHILDREN MUST BE FULLY POTTY‐TRAINED. No diapers or pull‐ups please. ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐  Girl  DATE:________________________________ Boy CHILD'S FULL NAME: _________________________ ____________________________ _________________________________________ First Middle Last NAME CHILD GOES BY:__________________________ NAME CHILD WILL LEARN TO PRINT:_____________________________________ CHILD IS: RIGHT HANDED_____ LEFT HANDED_____ UNDECIDED_____ ALLERGIES:________________________________________ CHILD'S ADDRESS: _________________________________________________________________________________________________ Street _________________________________________________________________________________________________ City State Zip NAME OF SCHOOL DISTRICT: _________________________________________________________________________________________ PARENT'S NAME: __________________________________________ ____________________________________________________ Father Mother PARENT'S ADDRESS: (Father or Mother)________________________________________________________________________________ If different from child’s. Street _______________________________________________________________________________ City State Zip TELEPHONE NUMBERS AND E‐MAIL ADDRESSES: DAD’S: Home_____________________ Work_____________________ Cell__________________ E‐Mail___________________________ MOM’S: Home_____________________ Work____________________ Cell__________________ E‐Mail___________________________ CHILD'S AGE AT PRESENT TIME: ___________ BIRTH DATE:_______________________________________________________ Month Day Year CHILD'S AGE BY AUGUST 1, 2015: ____________________ Note: A child MUST be 5 years old on or before August 1 to begin Kindergarten. Therefore, the same cutoff date “on or before August 1” is used for placement in the appropriate age Preschool class. PREVIOUS PRESCHOOL EXPERIENCE: __________________________________________________________________________________ Where? How Long? REFERRED BY? OR HOW DID YOU HEAR ABOUT OUR PRESCHOOL? _________________________________________________________ CONTINUED ON NEXT PAGE… Christ United Methodist Church Preschool Registration Form 2015‐2016 – Page 2 SELECT OPTION AVAILABLE CLASSES DAYS TIME SUPPLY FEE
TUITION/MONTH (Yearly) (Sept ‐ April) TUE/THU 9:30 AM – 12:30 PM $ 70 $ 130 FRIDAY ONLY 9:30 AM – 12:30 PM Tuition for 3’s AM Class changes: TUE/THU/FRI 9:30 AM – 12:30 PM $ 80 $ 160 MON/WED/FRI 9:30 AM – 1:30 PM $ 90 $ 210 MON/WED/FRI 9:30 AM – 1:30 PM $ 90 $ 210 (CHECK BOX) (September through first full week of May) 3's AM CLASS ADD: 1 DAY EXPLORER PROGRAM (Optional) – Class size limited to 12 ADD: FRIDAY EXPLORER CLASS 4's & 5's EXTENDED WITH LUNCH Student provides lunch. 5's EXTENDED WITH LUNCH* * Previous preschool experience in a 4 year old
class is required to enroll. Exceptions
can be made only by the Director. ADD: 1, 2 OR 3 DAY ENRICHMENT PROGRAM (Optional) – Class size limited to 12 ADD: MON ENRICHMENT ADD: MON & WED ENRICHMENT ADD: MON, WED & FRI ENRICHMENT 4’s & 5’s AM CLASS ADD: 4’s & 5’s THURSDAY (Optional) ADD: THURSDAY Tuition for 4’s & 5’s AM Class changes: MON/WED/FRI 1:30 PM – 3:30 PM MON 9:30 AM – 3:30 PM $ 100 $ 250 WED/FRI 9:30 AM – 1:30 PM MON/WED 9:30 AM – 3:30 PM $ 110 $ 275 FRI 9:30 AM – 1:30 PM MON/WED/FRI 9:30 AM – 3:30 PM $ 120 $ 300 MON/TUE/WED 9:30 AM – 12:30 PM $ 80 $ 160 THURSDAY ONLY 9:30 AM – 12:30 PM MON/TUE/WED/THU 9:30 AM – 12:30 PM $ 90 $ 210 TEACHER PREFERENCE: (If space is available.) _________________________________________________________________________ PARENT/GUARDIAN SIGNATURE:______________________________________________________________DATE:__________________ MAKE CHECKS PAYABLE TO CUMC PRESCHOOL THE REGISTRATION FEE OF $50 / $30 EACH ADDITIONAL CHILD (non‐refundable) IS DUE WITH THIS FORM. Christ United Methodist Church Preschool 318 N. Union Street P.O. Box 564 Westfield, Indiana 46074‐0564 Mrs. Barbara Sampson, Preschool Director CUMC Preschool Telephone: (317) 867‐0582 www.cumcpreschool.org Checks payable to: CUMC Preschool