[] 1 Step 1 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 Email (We distribute newsletters and other important news through email)a valid email 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.YesNo 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 choiceMonday/Wednesday/Friday a.m. (9 - 12 p.m.)Monday/Wednesday a.m. (9 - 12 p.m.)I would like to be added to the wait list for Tuesday/Thursday classes *Offered if interested Please upload an image of your child's birth certificate to verify their birth date. FileuploadUpload Submit Form Previous Next