Preschool Registration Form

N.B.U.M.C. Preschool Registration Form 2017

Child's Name *

First

Last

Male or Female *

Male Female

Nickname *

Birth Date *

Father's Name *

First

Last

Father's Mobile Phone *

Father's Home Phone *

Father's Email *

Fathers Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Father's Employer *

Father's Occupation *

Father's Work Phone *

Father's Work Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother's Name *

First

Last

Mother's Mobile Phone *

Mother's Home Phone *

Mother's Email *

Home Address *

Same As Father Different Address (fill in below)

Mother's Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother's Employer *

Mother's Occupation *

Mother's Work Phone *

Mother's Work Address *

Line 1

Line 2

City

State

Zip Code

Country

Please select the most appropriate answer: *

I give permission to NBUMC Preschool to use my name, child's name, address and phone number in school handbook. (Booklets are only distributed to preschool children's families.) No, I do not give permission.

Parents Marital Status *

Please list other household members, relationship to child, and the age of any siblings. *

IN CASE OF AN EMERGENCY, WHO SHOULD BE CALLED IF PARENTS ARE UNAVAILABLE?

Contact Name *

First

Last

Best Contact Number *

Relationship to Child *

Contact Address *

Line 1

Line 2

City

State

Zip Code

Country

Health Information

Are immunizations up to date? *

List of Allergies *

Special Medical Conditions *

After completing online application, please send a $25 (non-refundable) registration fee to:
New Brighton United Methodist Church Preschool (N.B.U.M.C Preschool)
1033 Sixth Ave.
New Brighton, Pa 15066

What preschool class do you prefer: 4 & 5 year olds *

What preschool class do you prefer: 3 year olds *

***If there are not enough children to justify an afternoon class, all children will be enrolled in the morning class.

Tuition Rates:
2-3 year olds - $450.00 ($50.00 per month)
4-5 year olds - $585.00 ($65.00 per month)

Application is only finished by coming to the Preschool, signing and putting down a deposit *

Accept and will come to Preschool

Submit

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New Brighton
United Methodist Church

1033 Sixth Ave. New Brighton, PA 15066 | (724) 843-3774 | nbumchurch@gmail.com

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