Preschool Registration Form

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

* Indicates required field

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

3 & 4 year olds meet Monday, Wednesday, and Fridays - 1:00 p.m. to 3:00 p.m.
4 & 5 year olds meet Monday, Tuesday, Wednesday, Thursday, and Friday - 9:00 a.m. to 11:30 a..m.

Tuition Rates:
3-4 year olds - $65.00 per month = $585 per school year
4-5 year olds - $110.00 per month = $990 per school year

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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The Cross and Flame is a registered trademark and the use is supervised by the General Council on Finance and Administration of The United Methodist Church. Permission to use the Cross and Flame must be obtained from the General Council on Finance and Administration of The United Methodist Church: