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PreK 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 $55.00 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 unless the application fee has been paid. 

How do you intend to pay?
If check, please include check number here.your full name
Please choose your schedule choice

*Special Schedule Notes: Extended days will be offered if 8 or more PreK students combined choose this option. You may choose one or two extended days in conjunction with the A.M. session.

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