• DUNLAP UNITED METHODIST PRESCHOOL

    23674 US 33 E // Elkhart, IN 46517 // (574) 875-7950
  • BASIC INFORMATION

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  • FAMILY BACKGROUND

    Parent and/or Guardian
  • Child Resides With:

    Select one by marking "x"
  • Concerning the parents:

  • Siblings:

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  • Person Responsible For Caring For My Child During The Day:

  • In Case Of Emergency

    Please list TWO people who should be called
  • Did someone refer you to us?YesorNo

  • Did Someone Refer You To Us?

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  • I hereby register my child in the Dunlap United Methodist Preschool. Included with this enrollment form is the NON-REFUNDABLE registration fee. I understand due to current seatbelt laws that it is my responsibility to transport or find responsible transportation, to and from all field trips. I further understand that my child will not leave the school premises without my knowledge.

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  • Class Selection

  • Health Information

  • Medical History

    Indicate if they have/have had the follow by answering YES or NO.
  • Does your child have...

    Answer Yes or No. Please explain each Yes answer.
  • A physical exam is NOT necessary for admission; however, a copy of your child's Birth Certificate and current Immunization Records are required for entrance into our preschool.

  • In the event of illness or accident which requires immediate medical treatment at a time when a parent/guardian cannot be located, I give permission for the Dunlap United Methodist Preschool to provide such emergency treatment to the best of their knowledge and ability. I will not hold the school or medical personnel responsible. This is to be done with the understanding that every attempt has been made to contact a parent, the child's physician, or other persons listed for emergency notification.

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