Davis Memorial Christian Church Preschool

Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician to call if child becomes ill or injured:
Name
Hospital or Clinic
Phone Number
Please enter a valid phone number.
There is an annual $10.00 registration fee per child, due with the Application.

This can be paid in person or mailed to:

Davis Memorial Christian Church

1500 West Franklin St.

Taylorville, IL 62568

**Tuition is due on or before the first day of each month.

**Scholarships are available

Please make checks payable to DMCC Preschool and include your child's name in the memo.
3 Year Old Class (Children must be 3 on or before September 1st)

Monday/Wednesday/Friday ($75.00/mo)
4 Year Old Class (Children must be 4 on or before September 1st)

Monday/Wednesday/Friday ($85.00/mo)

Emergency Contact