Lakeview UMC Preschool Registration Form
2016-17 School Year
Name of Parent(s) or Other Responsible Person(s)
Name of Student
Gender of Student
Date of Birth of Student
Physical Address of Home
Mailing Address (If Different)
Choice of Weekly Schedule (8:00AM-Noon Daily)
2 Days (Tues & Thurs) 2-3 Yr Olds @ $110/mo.
3 Days (Mon, Wed & Fri) 3-4 Yr Olds @ $120/mo.
5 Days (Mon - Fri) 4-5 Yr Olds @ $150/mo.
Primary Phone Number
Secondary Phone Number
Your Email Address
Student's Primary Physician
Physician's Phone Number
Person(s) to call in an emergency, if parents are unavailable. (PLEASE INCLUDE NAME, PHONE NUMBER, AND RELATIONSHIP)
Does the child have any medical conditions that the preschool staff should be aware of? If so, please explain.
Does the child have any dietary restrictions or food allergies? If so, please explain.
Please contact Amy Day at 377-1302 with any questions.
A NON-REFUNDABLE $100 registration fee is required with the submission of this registration form. Tuition (due on the 1st and late after the 9th of each month) can be paid online or in person.
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