Public 2024-2025 Preschool Registration Form

2024-2025 Preschool Registration Form

A non-refundable registration fee must accompany this form. Supply fees are due in September and January (half payments).
Class Choice

2-year-old class, M/W/F3-year-old class, T/W/Th4-year-old class, M-ThBible, Arts, Music (B.A.M!), F only, optional for 3- and 4-year-olds only
Child's Full Name*

First NameMiddle NameLast Name
Name Called*
Date of Birth*

MonthDayYear
Date
Home/Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name*

First NameLast Name
Relationship to Child*

MotherFatherGuardian
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address:*

Same as child'sDifferent than child's
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer*
Work Phone Number
Please enter a valid phone number.
Parent/Guardian's Name

First NameLast Name
Relationship to Child

MotherFatherGuardian
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Address:

Same as child'sDifferent than child's
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer
Work Phone Number
Please enter a valid phone number.
Emergency Contact (other than those listed above)*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Allergies or Dietary Restrictions*

NoYes
If yes, please list/explain:
Sibling(s) Name(s) and Age(s)*
Does your family attend church?*

YesNo
If so, where?
I understand that I must provide an up-to-date SC Certificate of Immunization DHEC 4024 before September 1, 2024*

YesNo
Current Immunization Record

Cancelof
How did you hear about us?*
Registration Fee ($130/child; $70 for additional siblings) must be paid with form to complete registration.*

I understand
Parent Signature*

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Date/Time*
Should be Empty: