2024/2025 Course Registration Form

Colbert Presbyterian Cooperative Preschool 2024-2025 and 2025/2026

Fill out the form carefully for registration *Registration is on a first come, first serve basis. We will email you to confirm your preschool registration once we have received your completed registration form and registration fee. The registration fee will be nonrefundable after registration and placement in class is confirmed.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Please select the school year you are registering for:*
Are your child's immunizations up to date?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/guardian name #1*

Parent/guardian first name #1Parent/guardian last name #1
Email address #1*
example@example.com
Parent phone #1*
Work Number #1
Parent/guardian name #2

Parent/guardian first name #2Parent/guardian last name #2
Email address #2
example@example.com
Parent phone #2
Work Number #2
Emergency contact #1*

NamePhone #
Emergency contact #2

NamePhone #
Adults (other than above) with permission to pick child up from preschool

Name #1Name #2
Additional information (allergies, special concerns, comments)-if none please indicate*
Will you be needing to utilize nursery care for younger sibling(s) on your volunteer day?

Colbert Presbyterian Church Cooperative Preschool Permission and Medical Release for Children
*(Child's full name) has my permission as his/her parent or legal guardian to participate in any and all events and activities sponsored or endorsed by Colbert Presbyterian Church and its Cooperative Preschool during the next twelve months.

I acknowledge that by participating in preschool-sponsored events my child may be involved in activities occurring both on and off church/preschool property.

I recognition of these risks and realities and in consideration of my child being offered the opportunity to participate in and benefit from these church/preschool-sponsored, I agree on behalf of my child to release, waive and disclaim any and all liabilities of or claims against Colbert Presbyterian Church and its Cooperative Preschool.

In the event my child requires emergency medical attention and I cannot be reached immediately, I give permission for Colbert Presbyterian Church (and Cooperative Preschool) staff, volunteers, teachers, or youth/children directors to authorize medical attention.

I further indemnify Colbert Presbyterian Church for any and all damage or injury my child may cause to others as a result of his/her participation in the preschool-sponsored events. I further understand that it is my responsibility to keep current the information contained on all record held in the church office including, but not limited to, my address, phone, emergency contact and insurance information.
Media Release*

I DO NOT give permission for any audio, video recording, or pictures of my child to be displayed on the church/preschool property or in brochures, newsletters, video productions, or other electronic media designed to inform the congregation and/or general public of the programs and events taking place in the church/preschool.I give permission for audio, video recording, or pictures of my child to be displayed on the church/preschool property or in brochures, newsletters, video productions, or other electronic media designed to inform the congregation and/or general public of the programs and events taking place in the church/preschool. I understand that my child will not be identified by name without my express written consent.
Your Full Name

First NameLast Name
Date*

MonthDayYear
Date
Please turn in $100 registration fee to Colbert Presbyterian Church upon completion of registration forms. Make check payable to Colbert Presbyterian Church with "Colbert Co-Op" in the memo line. Return to Colbert Presbyterian Church, 4211 E Colbert Rd., Colbert, WA 99005 *Or pay online: Using the "give" button, enter in the amount to be paid under "Preschool Tuition/Fees"
Should be Empty:

Colbert Presbyterian Cooperative Preschool 2024-2025 and 2025/2026

Colbert Presbyterian Church Cooperative Preschool Permission and Medical Release for Children