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3/4 Class Enrollment Application
Name of ChildLast, First, Middle
Date of Birth
Address (street, City, State, ZIP)your full name
Home Phone
Other Phone (i.e. Cell)
Name of Parent(s)/Primary Caregiversyour full name
Recommended By:your full name
Church Membership At:your full name
Previous Preschool or Day Care Attendedyour full name
Does your child have an IEP or FSP?If yes, a copy needs to be on file at the preschool.

A registration fee of $58 must accompany this application. This fee is non-refundable. There is also a church usage fee of $20 due prior to the first day of school. This application is not valid until the registration fee has been paid. Upon successful completion of this form you will be redirected to our secure PayPal portal to pay the registration fee.  

Please choose your schedule choice

*Offered if interested

Please upload an image of your child's birth certificate to verify their birth date. 

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