Child's Legal Name
*
First Name
Last Name
Child's Preferred Name (nickname)
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Child's Date of Birth
*
MM
DD
YYYY
Child's Gender
*
Child's T-Shirt Size
*
Youth X-Small
Youth Small
Youth Medium
Youth Large
Classes
*
Will you need before/aftercare?
*
If yes, which of the following will you need?
*
Does the child have a mother?
*
Mother's Name
*
First Name
Last Name
Does the mother live with the child?
*
Mother's Date of Birth
*
MM
DD
YYYY
Mother's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mother's Phone Number
*
(###)
###
####
Mother's Email
*
Is this child's mother employed?
*
Mother's Employer's Address
*
N/A if not applicable
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mother's Work Number
*
(###)
###
####
What's the best way to contact the mother?
*
Does the child have a father?
*
Father's Name
*
N/A if not applicable
First Name
Last Name
Father's Date of Birth
*
MM
DD
YYYY
Does the father live with the child?
*
Father's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Father's Phone Number
*
(###)
###
####
Father's Email
*
Is the father employed?
*
Father's Employer's Address
*
N/A if not applicable
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Father's Work Phone
*
(###)
###
####
What is the best way to contact father?
*
Marital Status
*
Who has legal custody of the child?
*
Specify if it is mom, dad, both, other, etc.
Does the child live with the person listed above?
*
Who does the child live with?
Who is financially responsible for the child's tuition?
*
Financially Responsible Person's Name
First Name
Last Name
Financially Responsible Person's Date of Birth
MM
DD
YYYY
What is their relationship to the child?
Financially Responsible Person's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Is the person responsible for tuition employed?
Financially Responsible's Work Info
Please list the following: Place of Employment, how long they have been employed there, and their occupation.
Financially Responsible's Employer's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Financially Responsible's Phone Number
(###)
###
####
Financially Responsible's Work Number
(###)
###
####
Financially Responsible's Email
Best way to contact this person
Emergency Contact
*
First Name
Last Name
Relationship to Child
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Work Phone
*
(###)
###
####
Best way to reach emergency contact
*
Child's Physician
*
First Name
Last Name
Physician's Phone Number
*
(###)
###
####
Does your child have any siblings?
*
Sibling's Name
First Name
Last Name
Date of Birth
MM
DD
YYYY
Sibling's Gender
Sibling's Grade
Sibling 2's Name
First Name
Last Name
Sibling 2's Date of Birth
MM
DD
YYYY
Sibling 2's Gender
Sibling 2's Grade
Sibling 3's Name
First Name
Last Name
Sibling 3's Date of Birth
MM
DD
YYYY
Sibling 3's Gender
Sibling 3's Grade
Does anyone else live in the house with the child?
*
Person's Name
First Name
Last Name
Person's Gender
Person's Date of Birth
MM
DD
YYYY
What's their relationship to the child?
Has your child previously attended preschool? If so, where?
*
How did you hear about New Haven United Methodist Preschool
*
Do you attend a church regularly?
*
If yes, which church?
*
Would you like more information about New Haven United Methodist Church?
*
Payment of the registration fee is nonrefundable
*
Tuition is due by the 15th of each month, beginning September 15th. We will set up an autopayment for tuition. If you choose to decline autopay, you will be charged a 5% increase to your child’s tuition.
*
I will keep my child home if they are showing signs of illness or communicable disease.
*
I will pick up my child promptly by the end of class each day. If late, I will pay a late student pick-up fee.
*
