Preschool Registration Test - Eighth Street Mennonite Church

Preschool Registration Form – SAMPLE ONLY

SAMPLE FORM ONLY – DO NOT USE FOR APPLICATION

If you would like to reserve a place in our program for your child, please complete the form below. There is a non-refundable registration fee of $30. Our spaces are filled in the order we receive your registration and the $30 fee. We need to have both in order to reserve a space for your child.

Sincerely,

Emma Dugger
Director
574-533-6720

Thank you for your expressed interest in Eighth Street Preschool. Your child must be 3 or 4 by Aug. 1st and potty trained to enroll at preschool. Our class options are listed below.

Full Name of Child(Required)

First Middle Last

Sex(Required)

Male

Female

Name you would like your child to be called

Date of Birth

Parent(s)

Mom

Cell

Dad

Cell

Child's Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone (if you have one)

Email (for preschool announcements)(Required)

Allergies(Required)

Yes

If yes, please list

Extended Day Preschool will be Mon, Wed, and Fri. from 8:30am – 1:30pm. The cost is $230/month. Our Extended Day program is designed to create a longer day for our Pre-K children. Each day they will be in a class mixed with children who may or may not be staying for the longer day from 8:30-11:30. At 11:30 Extended Day children will eat a sack lunch that you provide and then from 12:00-1:30 there will be more instructional time. During this time there is a little more structured focus on Kindergarten Readiness.

I want my child enrolled in the(Required)

3’s class 8:30am – 11:30am on Tuesday and Thursday $140/month

4’s extended day 8:30am – 1:30pm Mon, Wed, and Fri. $230/month

4’s A.M. only 8:30am – 11:30am Mon, Wed, and Fri. $160/month

The application fee is $1.00

Payment (select an option below)(Required)

I will pay by check or cash. I realize my application will not be processed until payment is received by the Preschool Office.

I will pay online by credit card

NOTE: This application will not be processed until payment is mailed to or submitted in person at the Preschool Office, 602 S. 8th St. Goshen, IN 46526 Phone: 574-533-6720

Your credit card will be charged the Preschool Application Fee:

Price:

Name of person making the payment – your name(Required)

First Last

Your email address(Required)

Billiing address of the credit card holder(Required)

Street Address City State ZIP Code

Credit Card(Required)

Cardholder Name

Card Details

Comments

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