—— Bethesda United Methodist Preschool ——

REGISTRATION FEE: A registration fee is due upon registering your child. This fee is NON-REFUNDABLE and is separate from tuition. Registration fees are the same as one month’s tuition.

TUITION: On or before August 1, September’s tuition is due. October – May is due on the first of each month one month in advance. Failure to pay September tuition by August 1 will result in the loss of placement. During the school year tuition is due by the 10th of each month. There is a $10.00 late fee for tuition received after the 10th of the month. There is a $25.00 fee for all returned checks.

Acceptance of this enrollment form and the non-refundable registration fee assures your child a place in our preschool. In return, we expect that you will honor your enrollment for the school year unless you move from the city.

I agree to honor this enrollment as described above. In case I do need to remove my child from the program, I will give one month’s notice or pay one month’s tuition.

Last Name: ____________________________________

First Name: ____________________________________

Sex: __________

Preferred Name: __________________________   Age as of Sept 1, current year: ________

Birthday: ________ / ________ / ________

Home phone: (          ) ________________________

Home Address: __________________________________________

City: ________________________________________ State: ____________

Zip: ______________

Parent's Martial Status:

Married: __________________________

Separated: __________________________

Divided: __________________________

Single: __________________________

If divorced, may either parent be contacted in an emergency? __________

May either parent pick up child?_____________

If divorced, please describe custody and visitation agreement for the child:

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You can help us plan for your child’s needs, understand concerns, and responses, and support and encourage your child by providing the following information. This information will remain confidential, and may be updated as needed.

Siblings:

Name: __________________________________    Age: ______________

Name: __________________________________    Age: ______________

Name: __________________________________    Age: ______________

Besides parents or guardians, other adults living in home:

Name: __________________________________ Age: __________

Relationship: ________________________

Name: __________________________________ Age: __________

Relationship: ________________________

Relationships:
List other significant persons in child’s life (step families, grandparents, baby-sitters, etc.)

Name: __________________________________    Relationship: ______________

Name: __________________________________    Relationship: ______________

Church Affiliation:

________________________________________________

Did your child attend a school last year?    Yes _______ No ________

If yes, where? ___________________________________________________

Development

Is your child potty-trained?    Yes _________ No _________

Have there been any births, deaths, adoption, or other changes in the family structure which affected you child? If so, describe briefly what happened and the effect on your child:

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Do you consider your child hard to manage or easily managed? (Describe)

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What methods of discipline have you found most effective?

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Does your child have any unusual fears? (Explain)

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Is any other language other than English used in the home? (Please describe)

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What opportunities does your child have to play with other children?

Family: __________ Neighborhood: _________

Sunday School/Church: ____________ Nursery/Classroom: _____________

Do you have any concerns about any aspect of your child’s development? (Please describe)

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