Note that each class listed below has a minimum and maximum enrollment. The days the classes are offered are subject to change due to COVID regulations and public school decisions. You will be notified of any changes.
2021-2022 Warrenton United Methodist Preschool and Childcare Registration Form
Effective 2/1/21
Child's Name
*
First Name
Last Name
Nickname
Date of Birth
*
-
Month
-
Day
Year
Date
Age of child on September 30, 2021
*
4 - 5 years (attending Kindergarten 2022-2023 school year)
4 years (not going to Kindergarten in 2022-2023 school year)
3 years
2 years
younger than 2 years
Class requested for SCHOOL YEAR program
The School Year program runs August 23 - May 20. If desired, payments can be divided into 9 payments, due the 1st of each month, August - April.
4 year old PK options:
5 day, 8:45 - 12:30. $3825
5 day, 8:00 - 4:00. $5400
4 day, 8:45 - 12:30. $3150
4 day, 8:00 - 4:00. $5400
3 day, 8:45 - 12:30. $2610
3 day, 8:00 - 4:00. $4275
3/4 year old preschool options:
5 day, 8:45 - 12:30. $3825
5 day, 8:00 - 4:00. $5400
4 day, 8:45 - 12:30. $3150
4 day, 8:00 - 4:00. $5400
3 day, 8:45 - 12:30. $2610
3 day, 8:00 - 4:00. $4275
2 day, 8:45 - 12:30. $2025
2 day, 8:00 - 4:00. $3240
2 year old options:
5 day, 8:45 - 12:30. $3825
5 day, 8:00 - 4:00. $5400
4 day, 8:45 - 12:30. $3150
4 day, 8:00 - 4:00. $5400
3 day, 8:45 - 12:30. $2610
3 day, 8:00 - 4:00. $4275
2 day, 8:45 - 12:30. $2025
2 day, 8:00 - 4:00. $3240
1 day, 8:45 - 12:30. $1035
Toddler options (16 months-24 months)
5 day, 8:45 - 12:30. $3825
5 day, 8:00 - 4:00. $5400
4 day, 8:45 - 12:30. $3150
4 day, 8:00 - 4:00. $5400
3 day, 8:45 - 12:30. $2610
3 day, 8:00 - 4:00. $4275
2 day, 8:45 - 12:30. $2025
2 day, 8:00 - 4:00. $3240
1 day, 8:45 - 12:30. $1035
Notes for the director about class requests:
I understand that my registration is not complete and my space will not be held until I have paid the annual $50/family registration fee (you will be directed to a screen to pay this online after submit or you can bring a check to WUMC)
yes
Gender
*
Male
Female
Does your child have any known allergies?
*
No
Yes
If you answered "Yes" to the above question, please list allergy, reaction, and treatment
Check any of the following illnesses your child has had
Asthma
Frequent Ear Infections or Ear Tubes
Mumps
Whooping Cough
Bronchitis
Eczema
Pneumonia
Polio
Chicken Pox
Frequent Colds
Croup
Convulsions
Measles
Influenza
Rheumatic Fever
Diphtheria
Tonsillitis
COVID19
Other
Does your child take any medication on a regular basis? If yes, please list name of medication, dosage and medical condition.
Please comment on any additional medical information/special need we should be aware of:
Does your child have any health issues or concerns in the areas of speech, vision, motor function, hearing? If yes, explain.
Do you have any concerns about your child's development?
As an attendee of WUMC children's programs, I am fully aware of the risk of exposure to COVID-19 and other illnesses. I am aware that WUMC has implemented preventative measures to reduce the spread of illness, however, I acknowledge that WUMC cannot guarantee that my child will not become infected with an illness while attending the children's programs. I recognize that changes to the program might have to be made with little notice and I agree to follow the guidelines and policies that WUMC establishes for the safety of all children and adults including, but not limited to:
Parents and other visitors will not be admitted to the children's area of the building; each individual will have their temperature taken before being admitted and children with a temperature over 100.3 degrees will not be admitted and must remain out until they are fever free with no fever reducing medication for 48 hours; children who exhibit signs of illness or fever over 100.3 will be sent home and must remain home until they are free of illness for 48 hours; children over age 2 will bring a face covering each day which will be used in the event the director or teacher deems it necessary for safety; all persons must clean their hands before entering the children's area.
Signature
Mother's Information
Mother's Name:
First Name
Last Name
Mother's Home Phone
-
Area Code
Phone Number
Mother's Cell Phone
-
Area Code
Phone Number
Mother's Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Place of Employment and Phone Number
Father's Information
Only complete if different from above
Full Name of Father
First Name
Last Name
Father's Home Phone
-
Area Code
Phone Number
Father's Cell Phone
-
Area Code
Phone Number
Father's Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Place of Employment and Phone Number
Family and Medical Information
Child's Doctor
*
Doctor's Office Phone Number
*
-
Area Code
Phone Number
Insurance Carrier
*
Insurance ID #
*
Emergency Contact #1, Relationship and Phone #
*
Emergency Contact #2 Relationship and Phone #
*
Names and Birthdates of Siblings
Persons authorized to pick up my child (include phone numbers and relationship)
*
Persons NOT authorized to pick up my child (list custody issues, etc)
Has your child had previous daycare or preschool experience away from home?
Please explain any concerns you may have (i.e fears, nap procedures, special discipline, etc.)
WUMC will notify the parent when the child becomes ill or is injured and the parent will arrange to have the child picked up as soon as possible. Parents are required to inform WUMC as soon as possible if the child develops any illness.
*
Agree
By clicking "Agree", you give permission for WUMC employees to apply as needed...diaper rash cream, band aids, 1st aid ointment.
Agree
Disagree
Do you have a special talent or skill that you would like to share with us?
Is there anything else you would like us to know about your child?
My child's Birth Certificate and Immunization Records must be on file before my child can enroll.
*
Agree
Disagree
Birth Certificate Number:
By clicking "agree", you authorize and give permission for your child to be transported to a hospital for evaluation and emergency medical or surgical treatment, including any necessary X-ray examination or diagnostic tests, or administration of medication. In consideration of the arrangements set forth herein, you do on behalf of yourself, your child, and your respective heirs, successors, assigns, and next of kin, release, waive, hold harmless, defend and covenant not to sue, Warrenton United Methodist Church and each of their respective departments, directors, administrators, teachers, officers, agents, representative, volunteers, and employees from any and all actions, claims, demands, or liabilities, including without limitation, those for personal injuries or property damage, that you and/or your child may suffer due to illness or injury suffered by your child as a result of this agreement, including medical treatment and any consequences that may arise as the result of this treatment, to the fullest extent permitted by law. You accept full responsibility for any medical or hospital bills associated with the care of your child.
*
Agree
Disagree
Signature
We like to take photos of the children playing and doing activities . We occasionally use the pictures in newsletters, outreach brochures, the WUMC website, and social Media. Children's names and/or ages are not used. Please notify us in writing if you do not want photos of your children published.
Save
Submit
Should be Empty: