2024-2025 Preschool Registration Packet

Preschool Registration Packet
Student Information
Child's Name

First NameMiddle NameLast Name
Nickname (if any)
Gender
Child's Birthday

MonthDayYear
Class

FrogsBeesPenguins
Additional paperwork required:*

NEW STUDENTS: I understand that I must submit the Virginia School Entrance Medical Form AND proof of my child's birth date before the registration packet is considered complete.RETURNING STUDENTS: I understand that I must submit updated immunization records for my child before the registration packet is considered complete.
You may drop off the proof of age and health forms at the preschool office. If you have the paperwork completed already, you can upload them below.
Proof of Birth Date (birth certificate or passport)

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Virginia School Entrance Health Form/Updated Immunization Records

Cancelof
Our Parent Handbook details all policies and procedures for St George's Preschool. A hard copy will be given to you on the first day of classes. Please review the Parent Handbook located here: Parent Handbook 2024-2025
Parent Handbook Acknowledgment:

I have read the Parent Handbook and agree to abide by the policies and procedures stated therein.
Parent's Signature

Clear

Tuition and Fees Agreement
Please INITIAL next to each statement and sign below.
Initials*I understand that tuition is based on a 9-month contract (September-May) and that the monthly rate is a calculation of the annual rate divided into 9 equal payments. I understand that the number of days in a month when school is in session does not affect the monthly payment rate, and that I will not receive adjustments in tuition fees for holidays or days missed. As long as my child is officially enrolled in preschool, tuition is due in full each month, regardless of illness, vacation, school holidays, scheduled breaks, or school closures during the 9-month academic year.
Initials* I understand that a one-time annual, nonrefundable Registration Fee of $195 is due at the time of registration. Payment of this fee reserves my child’s place in class for the entire school year.
Initials I understand and acknowledge that payment of the monthly tuition is due on the 25th of the previous month; for example, September tuition will be due on August 25th. I understand that I will be liable for a late fee of $20 if payment is not made/received by the 5th of the month. An additional $20 late fee will be charged if tuition is not paid by the 15th of the month.
Initials* I understand that for any checks returned for insufficient funds, I will be responsible to pay a $20 fee plus any bank fees.
Initials* I understand that if I choose to withdraw my child from St. George’s Preschool or decrease my child’s enrollment in the program, I must provide 30 days written notice. Less than 30-days notice will require a one month tuition payment.
I have read the Tuition and Fees Agreement and agree to abide by the policies and procedures stated therein.*

Clear

Pick Up Authorization
I grant permission for my child to be transported to and from the preschool by the person(s) listed below. I understand that a photo identification will need to be presented to the teacher or director by the person picking up my child.

Please list persons other than parents.
Name
Relationship to Student
Name
Relationship to Student
Name
Relationship to Student
Name
Relationship to Student
Name
Relationship to Student

Please list persons other than parents.*

	Name	Relationship to Student	Phone
1
2
3
4
5

Names of person(s) NOT legally authorized to pick up my child.
Parent's Signature*

Clear

Photo Policy Opt-In Form
St. George's UMC Preschool often uses photographs of students and families on bulletin boards and other displays; in slide shows or videos during special events such as Parent Coffee and Information Meetings and other preschool events; in newsletters or other preschool publications; and on our website or St. George's United Methodist Church's website or social media pages. It can be a great way to motivate and encourage our students and families. It is also an excellent outreach tool for guests and visitors who may be curious about what our events and activities are like.

St. George's UMC Preschool realizes the importance of maintaining the privacy of the children pictured in these media. There will be no student names used on the website or social media pages.

I understand that by granting permission on this form, photos or images of my child may be used on the St. George's UMC Preschool website, other preschool/church related websites, or preschool/church publications and social media sites.
Please choose one:*

I grant permission for the image or photo of my child to be used on the St.George's UMC Preschool website, other preschool/church related websites, preschool/church related social media sites, or preschool/church publications.I grant permission for the image or photo of my child to be used ONLY in classroom related publications. (Class books, bulletin boards, newsletters, emails to parents)
Signature*

Clear

Emergency Care Information
Chronic Physical Problems/Pertinent Developmental Information/Special Accommodations:

0/30
Previous Child Day Care Programs and Schools Attended:

0/25
If Child will attend this school and another school/program, give name of other school/program:
Parent/Guardian Information
Parent Contact 1:*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the child reside with this parent?*
Parent Contact 2:*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email*
example@example.com
Home Address (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the child reside with this parent?*
Persons or Agency Having Legal Custody of Child

First NameLast Name
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the child reside with this guardian?
Emergency Information
Allergies or intolerance to food, medication, plants, etc.*
If allergic reaction occurs, action to be taken in emergency:*
Child's Physician*
Physician Phone*
Please enter a valid phone number.
If parents cannot be reached, two people are required for emergency contact.

Please note priority order and means to contact.
Contact 1:*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to child*
Contact 2:*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to child*
Emergency Care Agreements
1. St. George’s UMC Preschool agrees to notify the parent(s)/guardian(s) whenever the child becomes ill and the parent(s)/guardian(s) will arrange to have the child picked up as soon as possible if so requested by the preschool.
2. The parent(s)/guardian(s) authorize St. George’s UMC Preschool to obtain immediate medical care of any Emergency occurs when the parent(s)/guardian(s) cannot be located immediately. Emergency medical care may include, but is not limited to, the following:
a. Administer appropriate First Aid or CPR by certified staff as needed
b. Call an ambulance
c. Call your child’s physician
d. Call emergency contacts listed on this page
3. The parent(s)/guardian(s) agree to inform St. George’s UMC Preschool within 24 hours or the next business day after his or her child or any member of the immediate household has developed a reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases which must be reported immediately.

I have read and agree to the above information and procedures.
Parent's Signature*

Clear
Director of Preschool

Clear

Family Information for Teachers
Mother's Name*
Mother's Occupation*
Father's Name*
Father's Occupation*
Does the child live at home with both parents? If not, can you provide the teacher with any information that will help her understand your child's home situation more clearly?*
Religious preference*
Language spoken at home*
Is your child with a caregiver during the day?*
If yes, how many hours?
If yes, in your home or caregiver's home?
Caregiver's Name
Does your child separate from you easily?*
Please list names and ages of siblings.*
Please list the kinds and names of pets in your home.*
Has your child had any previous school experience?*
If yes, how many years and what kind of experience?
What are his/her feelings about going to school?*
Does your child have an imaginary friend? If so, what is his/her name?
Does your child have a special "sleep" mate or comfort/security item? If yes, what?
Does your child have any fears? (i.e. the dark, thunder, etc.)
Does your child have any "jobs" at home? If yes, what are they?
Has your child experienced any emotional distress in the recent past? If yes, please explain:
Is there any learning difficulty that you, as a parent, think your child may be exhibiting? If yes, please explain:
Is your child receiving any special services from county/state agencies or a private source? If yes, please explain:
What are you, as a parent, hoping your child will receive from his/her preschool experience?
Is there any other information which you feel would help us better serve your child's needs at our school?
Should be Empty:

Preschool Registration Packet

Student Information

Tuition and Fees Agreement

Pick Up Authorization

Photo Policy Opt-In Form

Emergency Care Information

Parent/Guardian Information

Emergency Information

If parents cannot be reached, two people are required for emergency contact.

Emergency Care Agreements

Family Information for Teachers