Updated 2023-24 Student Registration

2023-2024 Registration Form

Fill out the form carefully for registration. Tuition is $2400/year per child. It is divided into ten monthly payments August through May. A $75.00 registration fee per child is required to reserve your child's spot.
Student Information

If registering multiple children, additional information can be added in another section.
Student Name *

First NameMiddle NameLast Name
Name child goes by
Birth Date*

MonthDayYear
Gender*
Class in which to be enrolled*
YesNo
If so, where
Are you a part of a local church? If so, please indicate which one.
Child's Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Allergies
Child lives with: Please include names of adults, relationship and names and ages of siblings*
Please include names of adults, relationship and names and ages of siblings.
Tell us about your child: (likes, dislikes, strengths)*
Does your child have any medical or developmental diagnoses? If so, what and provide any precautions or concerns pertinent to the diagnosis. *
Parent/Guardian Information
Mother's/Legal Guardian 1 Name*

First NameLast Name
Mother's E-mail*
example@example.com
Mother's Mobile Number*
Format: (000) 000-0000.
Address (if different than student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's/Legal Guardian 2 Name*

First NameLast Name
Father's Mobile Number*
Format: (000) 000-0000.
Father's Email
Address (if different that student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pick Up Authorization

In the absence of parents, child can be released to the following individuals. Photo identification will be checked prior to release.
Name

Full NameRelationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

Full NameRelationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

Full NameRelationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
If so, please upload a copy here or provide a copy to the SWPreschool Director prior to August 1, 2022

Court Orders
Cancelof
- Additional Children
  
  If you have additional children to register in the same household with at least one parent/guardian in common, please add their information here.
- Student #2 Name
  
  First NameLast Name
- Name to be used/written at school
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Gender
- Child lives with
- Class in which to be enrolled
- YesNo
- If so, where
- Primary Address (if different than Student #1's primary address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Allergy information
- Tell us about your child: (likes, dislikes, strengths)
- Does your child have any medical or developmental diagnoses? If so, what and provide any precautions or concerns pertinent to the diagnosis.
- Name of parent other than Father or Mother for child one, if applicable
  
  First NameLast Name
- Child #3
  
  If you have an additional children to register in the same household with at least one parent/guardian in common to child #1, please add their information here.
- Name
  
  First NameLast Name
- Name to be used/written at school
  
  NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Gender
- Class in which to be enrolled
- Child lives with
- YesNo
- If so, where?
- Primary Address, if different from Child #1
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Allergy information
- Tell us about your child: (likes, dislikes, strengths)
- Does your child have any medical or developmental diagnoses? If so, what and provide any precautions or concerns pertinent to the diagnosis.
- Name of parent other than Father or Mother for Child #1, if applicable
  
  First NameLast Name
- Release and Authorization
  
  By agreeing to questions and statements below, it is applicable to all children who are applying to enroll in SWPreschool.
- My Child(ren), Child #1 First Name Child #1 Last Name Child #2 First Name Child #2 Last Name Child #3 First Name Child #3 Last Name has/have my permission to attend SWPreschool sponsored by Southwest Christian Church from August 2023 through May 2024. We (I) recognize that this Contract is binding for the entire 2023-2024 school year and agree to the following terms:
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- YesNo
- The name and signature of the primary guardian is sufficient for the initial application. The second signature will be requested prior to start of the program, if applicable.
- Signature of Mother/Legal Guardian #1*
  
  Clear
- Signature of Father/Legal Guardian #2*
  
  Clear
- Name of Mother/Legal Guardian #1*
- Name of Father/Legal Guardian #2*
- Should be Empty:

2023-2024 Registration Form

Student Information

Parent/Guardian Information

Pick Up Authorization

Additional Children

Child #3

Release and Authorization

The name and signature of the primary guardian is sufficient for the initial application. The second signature will be requested prior to start of the program, if applicable.