| Preschool & Childcare Registration Form |
Date of Registration:
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Registration Fee: $50.00
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| Student's Full Name:
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Date of Birth:
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| Nickname:
NickName
Male:
Female:
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Telephone Number:
Phone
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Mailing Address (Street / PO Box, City, State, Zip):
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| Class Desired: Please check your first and second choice and the day-of-week |
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2-Year Olds 9:00 - 12:00 |
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T&Th
M, W, & F
5 Days
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3-Year Olds 9:00 - 12:00 |
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T&Th
M, W, & F
5 Days
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Pre-Kindergarten 9:00 - 12:00 |
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T&Th
M, W, & F
5 Days
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Pre-Kindergarten 12:30 - 3:00 |
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T&Th
M, W, & F
5 Days
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Pre-Kindergarten Combination 9:00 - 3:00 |
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T&Th
M, W, & F
5 Days
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Extended Care 7:30 - 9:00 |
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Approximate Times:
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Extended Care 12:00 - 4:00 |
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Approximate Times:
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Summer:
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| Father's Name:
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Father's
Home Address (Street / PO Box, City, State, Zip):
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| Father's Business Phone:
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| Father's Place of Employment:
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| Father's Occupation:
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| Mother's Name:
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Mother's
Home Address (Street / PO Box, City, State, Zip):
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| Mother's Business Phone:
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| Mother's Place of Employment:
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| Mother's Occupation:
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Sibling's Names & Ages:
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| Special Disabilities:
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Allergies:
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| Medication, Special Conditions:
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Medical Needs in an Emergency:
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| Has your child attended school? Yes
No
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Is your child toilet trained? Yes
No
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| Can our child express basic needs in English? Yes
No
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Language Spoken at Home:
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Please list special needs or fears:
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| Are you a member of Mt. Nittany United Methodist Church? Yes
No
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Race (This information is not needed for registration. It isused for government census reports only):
Cuucasian:
Hispanic:
Native American:
African American:
Asian:
Other:
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How did you hear about Mt. Nittany Preschool?
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| Parental Consents (Note: Be sure to sign for any of these on the next page) |
| Obtaining Emergency Medical Care Approved:
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| Administration of Minor First Aid Procedures Approved:
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| Walking Field Trips Approved:
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| Photos & Videos Taken to Advertise School Approved:
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Any additional information that you feel would be helpful:
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The next screen will display your registration form in PDF format (you will need Adobe's Reader to continue). Please review for accuracy, print a copy for your records, and mail the completed registration form and fee check to:
Mt. Nittany Preschool
P. O. Box 1103
Lemont, PA 16851 |