Enrollment Form 2021/22

Date

Month / Day / Year

Gender *

Boy Girl

Student Name *

First Name Last Name

Birth Date *

Month Day Year

Age (as of Sept 1) *

Guardian Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State

Zip Code

Phone Number *

Area Code Phone Number

E-mail *

Church Affiliation / Home Church:

Referred by:

Class Signup:

Age Requirements for each class is September 1st.

2 & 3 year olds do NOT need to be toilet trained to attend our classes.

4 & 5 year olds Must be toilet trained to attend our classes.

2 Year Old Program (Must be 2 by September 1st)

N/A - THIS CLASS OPTION IS FULL

3 Year Old - 3day Program (Must be 3 by September 1st)

N/A - THIS CLASS OPTION IS FULL

PreK 1 - 3day Program (Must be 4 by September 1st)

N/A - THIS CLASS OPTION IS FULL

PreK 1 - 4day Program (Must be 4 by September 1st)

N/A - THIS CLASS OPTION IS FULL

PreK 2 - 4day Program (Must be 4 1/2 by September 1st)

N/A -THIS CLASS OPTION IS FULL

1/2 day classes have a one-time Workbook fee of $50 due in August.
Full Day classes have a one-time Workbook & Materials fee of $75 due in August.

*Tuition is based on an annual fee and broken down into nine (9) monthly payments for your convenience. First month's tuition is due by August 30th. All other payments are due by the end of each month, the last payment being the end of April. All accounts must be paid in full by April 30th in order to attend the last month of school and graduation.

Enrollment fee for 2021/2022 is $60.00

*You may pay the Enrollment Fee by mailing it to us, dropping it off in our church office or preschool office, or online payment via paypal. If you choose to pay online there is a transaction fee of $3.00.

Mailing Address is: 1500 Lower Huntington Road, Fort Wayne, IN 46819

By pressing "Submit Form", you are stating that you understand that the $60 enrollment fee is non-refundable, and is needed to secure your child's place on the enrollment list.

Enrollment Fee *

Mail Payment (1500 Lower Huntington Road, Fort Wayne, IN 46819) Drop Off Payment (1500 Lower Huntington Road, Fort Wayne, IN 46819) Online Payment (PayPal - select option below)

PayPal Payment Selection

Enrollment Fee (includes transaction fee) $ 63.00

Submitting the enrollment fee will secure a place on the enrollment list.

Book Fee - 1/2 Day Class (optional now - due in August) $ 50.00

Book Fee can be included but is optional until August.

Book Fee - Full Day Class (optional now - due in August) $ 75.00

Book Fee can be included but is optional until August.

Total $ 0.00

ENROLLMENT FORM 2021/22