Enrollment

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MOUNT PLEASANT METHODIST CHURCH

SUMMER PRESCHOOL INFORMATION SHEET

Summer of 2024

Child’s Full Name

Child's Birthday

Name child goes by

Child's Home Phone

Child's Address

Mother/Guardian

Mother's Home Phone

Mother's Mobile Phone

Mother's Address

Mother's Place of Employment

Mother's Business Phone

Father/Guardian

Father's Home Phone

Father's Mobile Phone

Father's Address

Father's Place of Employment

Father's Business Phone

Mother's Birthdate

Father's Birthdate

Email 1

Email 2 (optional)

Siblings

Church

Person(s) allowed to pick up my child:

In case of emergency and I cannot be reached, please notify:

Any known allergies to food/medicine?

Yes, food allergies

Yes, medication allergies

Yes, both food/medication allergies

In case of emergency and I cannot be reached, please follow instructions as listed below for my child

Doctor’s Name / Office

Doctor's Office Number

Dentist’s Name / Office

Dentist's Office Number

Please give any information concerning your child which will be helpful in his experience in group setting (such as play, eating habits, special fears, special likes)

Yes, all information provided is correct

I have read and agree to registration & tuition fees

Child's Name

Your Signature

Date

Your Signature

Date

Your Signature

Date

Thank you for your application!

Registration/Tuition Fee Agreement

Acceptance of this form and the registration fee assures your child a place in our preschool. The registration fee is non-refundable.

I have received a copy of Mt. Pleasant Preschool’s fee schedule and I agree to pay the required tuition

no later than the 15th of each month. I am aware that there is a $10.00 penalty for late payments per occurrence. I also am aware that there is a $15.00 charge for any checks returned for insufficient funds.

Emergency Treatment

In the event of an illness or accident which requires immediate treatment at a time when a parent cannot be located, I give permission for Amy Howard, Director, Mt. Pleasant Preschool, or any other preschool personnel designated by the director, to authorize such treatment. I will not hold the preschool or medical personnel responsible. This is done with the understanding that every attempt will have been made to contact the parents, the child’s physician, and other persons listed for emergency contact.

Outings on Mt. Pleasant Church property

I give my permission for my child to accompany his/her class and teachers during outings on Mt. Pleasant Church property. These may include nature walks, devotions, or outside play.

I understand that I will be required to provide any transportation for off campus field trips for my child.

Photo Release (optional)

I give permission for my child’s picture to be used on Mt. Pleasant Preschool’s Facebook page, website, news media, in hallway displays and any video that may be shown to the church congregation. Please know that at no time will your child’s name be mentioned.

I verify all information is correct: