King of Glory Preschool
Registration Form ~ 2008-09

CHILD’S NAME:____________________PARENTS: _____________________

ADDRESS:_________________________ CITY: ______________ZIP:_______

PHONE # ______________________DATE OF BIRTH: ___________________

MAJOR CROSSROADS:____________________________________________

AGE: ________________________________SEX: ______________________
(as of 09/01/08)

Please mark your choice of class below:

2 ½ - year - old Class: 2 ½ by September 1, and potty trained.

Monday, 9 – 11:30 a.m. …..............................….$53.00 / month
3 – yr – old Class: 3 years old by October 1.
Tuesday/Thursday, 9 – 11:30 a.m........................$102.00 / month

Wednesday/Friday, 9 – 11: 30 a.m..................…$102.00 / month
3 & 4 – year – old Class 3 years old by April 1
Tuesday/Thursday, 12:15 – 2:45 p.m…................$102.00 / month
4 – year – old Class: 4 years old by October 1.

Monday/Wednesday/Friday, 9 – 11:30 a.m. …….$133.00 / month

Tuesday/Thursday, 9 – 11:30 a.m. ……………….$102.00 / month
Pre-Kindergarten Class: 5 years old by December 31.
Mon/Tues/Wed/Thurs, 12:15 – 2:45 p.m. ………..$165.00 / month
A registration fee of $70.00 must accompany this application and includes a free King of Glory Preschool T-Shirt. If you are enrolling more than one child, there is a 10% discount for the second child for registration and tuition.
Amount Paid___________ Check #____________ Date______________ T-Shirt Received_________

Registration is considered complete when the following paperwork has been submitted:

_____Blue Emergency Card (including all addresses and required signatures)

_____Immunization History Faxed from immunizing physician ~or~ bearing physician/clinic stamp

_____Parent Agreement (on the reverse side of this form)
King of Glory Preschool admits students of any race, color and national or ethnic origin and in compliance with the American Disabilities Act of 1996, accepts
children with disabilities.