Ymca Preschool Registration Form - 2016-2017 printable pdf download

YMCA PRESCHOOL REGISTRATION FORM

2016-2017 School Year

One child per registration form

Please return the attached registration form, attention

Margo Dietz or Cheryl Ballard with a $40 non-refundable registration fee.

Date of Application ________________________________

Child’s Name ___________________________________________________________________________________________________________________________________________________

How do you want your child’s name to appear in the classroom? ________________________________________________________________________________

Male ___________

Female ___________

Child’s Birthday _____________________________ Age on September 1, 2016 ___________________________

Address ___________________________________________________________________________________________________________ Home Phone ____________________________

City _________________________________________________________________________________Zip__________________________

Family E-mail Address (please print clearly) ___________________________________________________________________________________________________________

Mother’s Name __________________________________________________________________________________________________ Home Phone ____________________________

Address ___________________________________________________________________________________________________________ Work Phone ____________________________

Cell ____________________________________________________

Father’s Name __________________________________________________________________________________________________ Home Phone ____________________________

Address ___________________________________________________________________________________________________________ Work Phone ____________________________

Cell ____________________________________________________

Name of person completing this form ____________________________________________________________________ Phone ____________________________________

Please choose a first and second class preference:

1) _____ T/Th morning (8:30 a.m.-11:00 a.m.) Three & Four Year Olds

$96 per month

(Must be 33 months by September 1, 2016, toilet trained, and not old enough to enroll in PreK classes)

$96 per month

2) _____ T/Th morning (9:30 a.m.-12:00 p.m.) Three & Four Year Olds

(Must be 33 months by September 1, 2016, toilet trained, and not old enough to enroll in PreK classes)

3) _____ T/Th afternoon (12:15 p.m.-2:45 p.m.) Three, Four & Five Year Olds $96 per month

(Must be 3 by September 1, 2016, toilet trained, and not old enough to enroll in PreK classes)

4) _____ M/W/F morning (8:30 a.m.-11:00 a.m.) Four & Five Year Olds