LKR Preschool Enrollment

Child's Name*

Gender*

BoyGirl

Nickname

Birthdate*

Date

Age (as of Sept 1, 2024)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone #*

Area CodePhone Number

Email*

example@example.com

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Class Preference: (please check one)

Checking a class below does not guarantee a spot in that class, however we will make every effort to honor your first choice.

Please select which class you are enrolling your child in:*

3 year old (must by 3 by Sept 1, 2024) - $100 per month3-4 year old (must be 3 by March 1, 2024 - $145 per month4-5 year old (must be 4 by Sept 1, 2024) $195 per month

3 Year old classroom (must be 3 by September 1, 2024) - $100 per month tuition

M/W A.M. - 9::00 - 11::30Tu/Th A.M. - 9::00 - 11::30

3-4 Year old classroom (must be 3 by March 1, 2024) - $145 per month tuition

T/W/Th A.M. - 9::00 - 11::30

4-5 year old classroom (must by 4 by September 1, 2024) - $195 per month tuition

M-Th A.M. - 9:00 - 11:30M-Th P.M. - 12:30 - 3:00

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Parent/Guardian Information:

Guardian/Parent Name*

Cell Phone #*

Area CodePhone Number

Work Phone #

Area CodePhone Number

Guardian/Parent Name*

Cell Phone #*

Area CodePhone Number

Work Phone #

Area CodePhone Number

Please click on the following link and complete the forms in that file. They are REQUIRED for all students and must be turned in BEFORE your child's first day of attendance. Forms can be mailed or delivered to the church office: South Rock Christian Church, 900 S Rock Rd, Derby, KS, 67037.

REQUIRED FORMS - CLICK HERE

Church Affiliation

How did you hear about our program?

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WAITLIST

At this time our classes are full but you will be added to the waitlist for the 2024-2025 school year. Should a spot open up you will be notified in the order that forms are received and payment will be done at that time.

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Payment Options

Pay now (credit-card)Pay later

Payment

LKR Preschool - Non-Refundable Enrollment Fee$75.00

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Little Kids Rock Preschool admits students of any race, color, national origin, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. Little Kids Rock Preschool doesn't discriminate on the basis of race, color, national origin, and ethnic origin in administration of its educational policies and other school-administered programs.

2024-2025 Enrollment Form