Step 1 of 9 11% Preschool RegistrationAll the areas with this symbol (*) must be filled out.Student InformationToday's Date* Date Format: MM slash DD slash YYYY Student's Name (First, Middle, & Last)* First Middle Last Child's Name/Nickname you want on class list* Name/Nickname Gender*MaleFemaleAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Phone*Medical Form (Not required until first day of school)Accepted file types: jpg, png, pdf, .Date Of Birth* Date Format: MM slash DD slash YYYY Birth Certificate*Accepted file types: jpg, png, pdf.Please supply a copy of the child's birth certificate.Child Attended Presby Preschool for the 2019-20 School year:*Select OneYesNoElementary School District* Parent(s)/GuardianFirst Parent/Guardian* First Last Relationship To Student*Select OneMotherFatherGrandparentAuntUncleOtherOther Relationship*Occupation/Employer*Work Phone*Second Parent/Guardian* First Last Relationship To Student*Select OneMotherFatherGrandparentAuntUncleOtherOther Relationship*Occupation/Employer*Work Phone* Do They Have Any Other Siblings?*Select OneYesNoSiblings (Name & Ages)*NameAge Permission Contact Details*I agree to have my name, address & phone number included on my child's class roster which will be supplied to the class.Select OneYesNoPermission Parent Support Team*I would like to be a member of the Parent Support TeamSelect OneYesNo Do You Have A Parent Not Living In Household*Select OneYesNoAny Parent that does not live in the same house as the child.Name* First Last Relationship To Student*Select OneMotherFatherGrandparentAuntUncleOtherOther Relationship*Custody Arrangements*Please list legal custody arrangements and any other pertinent information. (You must supply us with a copy of any restraining, custody, visitation, orders and Adoption decree. We will keep this on file.)Upload*Restraining, Custody, Visitation, Orders and Adoption decree. Drop files here or Accepted file types: jpg, png, pdf. Church Affiliation* Do You Have A Caregiver During The Day?*If both parents are out of the home during the day Then "YES" you have a caregiverSelect OneYesNoCaregiver's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Caregiver's Phone Number* Written AnswersLanguage spoken in home*What are your child's interests?*Do you know any of your child's fears?*Please note any special food habits, allergies, problems, etc.*Does your child have any speech, hearing, or other problems of which we should be aware?*Does your child have special names for objects (bathroom, drink, etc.)?*What method of behavior control is used at home?*Has your child had any previous group experience outside the home; if so, where and was this an enjoyable experience?*How would you describe your child's personality?* I Would Like For My Child To Attend...Please choose your first choice and the second choice incase your first choice is full!Please Select Option OneAge by Aug. 1, 2020*Select One2345Do You Want A 2 Day Or 3 Day Class?*This is how many classes they will have per week.2 Day3 DayDo You Want A 3 Day, 4 Day Or 5 Day Class?*This is how many classes they will have per week.3 Day4 Day5 Day ExtendedDo You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Th-Fr)Afternoon (Mon - Tues)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Wed)Afternoon (Mon - Wed)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Wed)Afternoon (Mon - Wed)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Thur)Afternoon (Mon - Thur)2's (2 by Aug. 1, 2020)*2 day 9:15-11:15 Th-Fr Price: $95.00 3's (3 by Aug. 1 2020)*2 day 9:00-11:30 Th-Fr Price: $90.00 3's (3 by Aug. 1 2020)*2 day 1:00-3:30 M-T Price: $90.00 3's (3 by Aug. 1 2020)*3 day 9:00-11:30 M-W Price: $110.00 3's (3 by Aug. 1 2020)*3 day 1:00-3:30 M-W Price: $110.00 4's & 5's Readiness*3 day 9:00-11:30 M-W Price: $110.00 4's & 5's Readiness*3 day 1:00-3:30 M-W Price: $110.00 4's & 5's Readiness*4 day 9:00-11:30 M-Th Price: $130.00 4's & 5's Readiness*4 day 1:00-3:30 M-Th Price: $130.00 5 day Extended*5 day Extended 9:00-12:00 M-F Price: $170.00 Please Select Option TwoAge by Aug. 1, 2020*Select One2345Do You Want A 2 Day Or 3 Day Class?*This is how many classes they will have per week.2 Day3 DayDo You Want A 3 Day, 4 Day Or 5 Day Class?*This is how many classes they will have per week.3 Day4 Day5 Day ExtendedDo You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Th-Fr)Afternoon (Mon - Tues)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Wed)Afternoon (Mon - Wed)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Wed)Afternoon (Mon - Wed)Do You Want A Morning Or Afternoon Class?*Mornings = 9:00 - 11:30am & Afternoon = 1:00 - 3:30pmMorning (Mon - Thur)Afternoon (Mon - Thur)2's (2 by Aug. 1, 2020)*2 day 9:15-11:15 Th-Fr Price: $95.00 3's (3 by Aug. 1 2020)*2 day 9:00-11:30 Th-Fr Price: $90.00 3's (3 by Aug. 1 2020)*2 day 1:00-3:30 M-T Price: $90.00 3's (3 by Aug. 1 2020)*3 day 9:00-11:30 M-W Price: $110.00 3's (3 by Aug. 1 2020)*3 day 1:00-3:30 M-W Price: $110.00 4's & 5's Readiness*3 day 9:00-11:30 M-W Price: $110.00 4's & 5's Readiness*3 day 1:00-3:30 M-W Price: $110.00 4's & 5's Readiness*4 day 9:00-11:30 M-Th Price: $130.00 4's & 5's Readiness*4 day 1:00-3:30 M-Th Price: $130.00 5 day Extended*5 day Extended 9:00-12:00 M-F Price: $170.00 Registration Payment*Select OneNew Student - $65Returning Student - $55OtherCustom Price*Please enter the price that Kathy gave you to pay Credit Card* Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.
