Graceful Beginnings Registration

Graceful Beginnings Registration Form
All registrations are received and reviewed on a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Today's Date

MonthDayYear
Date
Student Information
Student First Name*
Student Last Name*
Preferred Name
Email*
example@example.com
Gender*

FemaleMale
Birth Date*

MonthDayYear
Age

2345
Student lives with (Check all that apply)

Both ParentsFatherMother
County or City Students resides
Preschool 2-5 years of age

Applying for: Full Time (Monday - Friday), 3 days a week (Monday, Wednesday, Friday) or 2 days a week (Tuesday/Thursday)
2 days a week (Tuesday/Thursday)3 days a week (Monday, Wednesday, Friday)5 days a week (Monday through Friday)
Family Information
Mother

First NameLast Name
Mother's E-mail
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Employer
Church Affiliation
Father

First NameLast Name
Father's E-mail
Home Address (if different from Mom)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Employer
Other Information
Does your child have any allergies, medical conditions, or learning disabilities? If so, please describe below.
Is your child potty trained*? (All students wishing to enter the 3 or 4 year-old classrooms MUST be fully potty trained.)

YesNo
COMMITMENT:

Yes, I agree to pay all tuition charges and fees on or before their assigned due date. Tuition is due regardless of closures such as teacher workdays, weather, etc.
Registration Fee & Forms*

I understand that the NON-REFUNDABLE registration fee of $75 per child must be paid before the application can be processed.
Signature of Parent

Clear
Signature of Parent

Clear
All registrations are received and reviewed on a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.
Should be Empty:

Graceful Beginnings Registration Form

Student Information

Preschool 2-5 years of age

Family Information

Other Information