Preschool Registration Form

Please complete your child's information below:
After submission, please follow the link to pay the registration fee.

Child's Name (use preferred name)

First Name Last Name

Male/Female

Child's Birthday

Date

Age as of Sept. 1, 2023

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Mother's Name

First Name Last Name

Mother's Phone Number

Please enter a valid phone number.

Mother's Email Address

example@example.com

Father's Name

First Name Last Name

Father's Phone Number

Please enter a valid phone number.

Father's Email Address

example@example.com

Family Status:

MarriedDivorcedOther

Child lives with:

MotherFatherBothOther

Is your family an active member of St. Peter Chanel? (Parish status as of 12/1/22)

YesNo

Primary language spoken at home:

How did you hear about SPC Preschool?

Does your child have an allergy that requires medication?*

Yes (Please specify what allergy & medication required below)No

If yes, please specify the allergy & medication here:

Does your child have a condition that requires a physician's care?*

Yes (Please specify below)No

If yes, please specify here:

Does your child have an allergy that is non-food related:*

Yes (Please specify what allergy below)No

If yes, please specify here:

Does your child have any other special considerations of which we need to be aware? Please let us know here:*

Has your child ever been evaluated for a speech, language or learning concern:*

Yes (Please specify below)No

If yes, please specify here:

Class Selection

Class eligibility is based on age of child on 9/1/2023
Ages
18-24 month: Child must be 1 year old by March 1 & walking by first day of school
PreK Plus: Child turns 5 between June 1 and November 30

School Hours
18-24 month: 9:30am - 12:45pm
2yr, 3yr & 4yr old classes: 9:30am - 1pm
PreK Plus class: 9:30am - 1:30pm

Please select your class choice:*

2nd class choice, if applicable:

3rd class choice, if applicable:

Additional comments or requests?

NOTE: If there are more registrations than spaces available within a priority group,
we will utilize a "lottery" and the children will be randomly chosen for the
available spots.

Priority groupings:
1. Returning students
2. Silbings of current/alumni students
3. Parishioners
4. General public

Upload Birth Certificate Here:*

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A copy of child’s official State Birth Certificate is required at the time of registration. (For children currently enrolled we will verify you have a copy on file.)

Upload Form 3231 Here:*

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St. Peter Chanel Preschool is required by the State of Georgia and the Archdiocese of Atlanta to have a current GA Immunization Form 3231 on file for each child. This form needs to be received at the time of registration. It is required that they be current and complete. The Archdiocese of Atlanta does not recognize an immunization exemption based upon matter of conscience/ religious convictions and does not accept any alternative or homeopathic immunization that has not been approved by the FDA. Medical exemptions are determined by a physician when a child has a long term condition that contraindicates immunizations. You must obtain a copy of the Georgia State Form 3231 from your child’s pediatrician or the Health Department. We can only accept the State of Georgia 3231 form as a valid record. (For children currently enrolled we will verify that you have a current copy on file.) Waivers to exempt vaccines will NOT be accepted.

All documents including registration payment must be submitted by February 1, 2023
by 10:00am to be considered for registration.

Tuition Agreement:

First of 9 payments will be due May 10, 2023 for all classes, 8 remaining monthly payments are due 9/1/2023 - 4/1/2024. Instructions to set-up e-Tuition payments will be provided with the registration confirmation.
The first payment is non-refundable for withdrawl made prior to September.
(Registration fee is non-refundable if offered class placement.)

I deem that all information provided on this form is correct and current.
I agree to the tuition statement.

During completion of registration for the 2023 - 2024 school year, registration fees are due at this time. If there is an updated immunization record, be make sure you have uploaded it this registration form above.

Parent Partnership of Faith:
I understand that by entering this agreement, I agree to fully embrace the mission of St. Peter Chanel Preschool and intend to enter into full partnership with our parish faith community as a responsible steward and discple of Christ.

After you submit, please follow the link to pay the registration fee.

Signature

Clear

Date

To be filled out by office:

Registration Fee Paid: _____Y ______N ____Online _____Check # ______Amnt Paid

Birth Certificate on file _____Y ______N

Immunization Form on file _____Y ______N

St. Peter Chanel welcomes all children regardless of their national origin, race or religion.

St. Peter Chanel Catholic Church