Welcome to registration! Before you begin, please make sure you have at least 20 minutes to fill out this form! We thank you for choosing Presby Preschool and we look forward to serving you! 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 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 (Not required until first day of school)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 OneYesNo Parent(s)/GuardianFirst Parent/Guardian* First Last Email* Enter Email Confirm Email Phone*Relationship To Student*Select OneMotherFatherGrandparentAuntUncleOtherOther Relationship*Occupation/Employer*Work Phone*Second Parent/Guardian* First Last Email* Enter Email Confirm Email Phone*Relationship To Student*Select OneMotherFatherGrandparentAuntUncleOtherOther Relationship*Occupation/Employer*Work Phone* Does Your Child Have Any Other Siblings?*Select OneYesNoSiblings (Name & Ages)*NameAge POP!*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?*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?*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, 2021*Select One345Do You Want A 2 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 (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)3's (3 by Aug. 1 2021)*2 day 9:00-11:30 Th-Fr Price: $105.00 3's (3 by Aug. 1 2021)*3 day 9:00-11:30 M-W Price: $130.00 3's (3 by Aug. 1 2021)*3 day 1:00-3:30 M-W Price: $130.00 4's & 5's Readiness*3 day 9:00-11:30 M-W Price: $130.00 4's & 5's Readiness*3 day 1:00-3:30 M-W Price: $130.00 4's & 5's Readiness*4 day 9:00-11:30 M-Th Price: $155.00 4's & 5's Readiness*4 day 1:00-3:30 M-Th Price: $155.00 5 day Extended*5 day Extended 9:00-12:00 M-F Price: $200.00 Please Select Option TwoAge by Aug. 1, 2021*Select One345Do 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 (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)3's (3 by Aug. 1 2021)*2 day 9:00-11:30 Th-Fr Price: $105.00 3's (3 by Aug. 1 2021)*3 day 9:00-11:30 M-W Price: $130.00 3's (3 by Aug. 1 2021)*3 day 1:00-3:30 M-W Price: $130.00 4's & 5's Readiness*3 day 9:00-11:30 M-W Price: $130.00 4's & 5's Readiness*3 day 1:00-3:30 M-W Price: $130.00 4's & 5's Readiness*4 day 9:00-11:30 M-Th Price: $155.00 4's & 5's Readiness*4 day 1:00-3:30 M-Th Price: $155.00 5 day Extended*5 day Extended 9:00-12:00 M-F Price: $200.00 Registration Payment*Select OneNew Student - $75Returning Student - $65Second Child - $10OtherCustom 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.
