Jasper United Methodist Church Preschool 2024-2025 Application for Admission Registration Form Step 1 of 2 50% Application for Admission A $75.00 non-refundable registration fee and $40.00 activities fee is due at the time of registration. Please pay online at jasperumc.org select fund Preschool Tuition/Registr or bring a check/cash to the preschool office. Family Information Please complete all questions. The Form will not allow you to move to a new section until all questions are answered. Please type N/A if a question is not applicable.Select Desired Preschool Class. Children must be of age by September 1st for the class they are entering. Children entering the 3 year old classes should be fully potty trained. *(Required) 15 - 24 months (Three days: M, T, W) 15 - 24 months (Five days: M - F) 2 year olds (Three days: M, T, W) 2 year olds (Five days: M - F) 3 year olds (Three days: M, T, W) 3 year olds (Five days: M - F) Pre-Kindergarten 4 year olds (Five days: M - F) Child's Full Name(Required) Name Child Goes By(Required) Date of Birth(Required) MM slash DD slash YYYY Child's Age as of September 1, 2024(Required) Children must be of age by September 1st for the class they are entering. Children entering the 3 year old classes should be fully potty trained.Gender: Male or Female(Required) Male Female Child's Primary Address (including city and Zip code)(Required) Street Address Address Line 2 City ZIP Code Father's Name(Required) First Last Address (if different from child) Street Address Address Line 2 City ZIP Code Father's Email Address(Required) Father's Cell Phone and Work or Other Number(Required)Father's Place of Employment(Required) Mother's First and Last Name(Required) First Last Address (if different from child) Street Address Address Line 2 City ZIP Code Mother's Email Address(Required) Mother's Cell Phone and Work or Other Number(Required)If there is a separation or divorce in the family, please complete the section below: If separated or divorced, with which parent does the child reside? Please describe the custody agreement regarding either parent visiting classes or taking the child from school, name of legal guardian and home phone number. Please type N/A if not applicable.Emergency Contacts/Authorized Individuals To Whom Child May Be Released. You may list up to 6 individuals. Please include phone numbers.(Required)NamePhone Number Add Removeclick the + sign to add another individual (add up to 6 individuals)Persons NOT AUTHORIZED to pick up your child. Type N/A if not applicable(Required) Are there any family situations or special concerns that we should know in order to best care for your child? Type N/A if not applicable.(Required) Does the applying child have any siblings that currently attend or are applying to JUMC Preschool? If yes, please list name and ages. Child's Health Information Please complete all questions. The Form will not allow you to move to a new section until all questions are answered. Please type N/A if a question is not applicable.Please list any allergies or medical conditions your child may have (type N/A if not applicable)(Required) Please list any medications your child takes regularly (type N/A if not applicable)(Required) Does your child have any special needs or receive any resource help? *~*Please specify*~* Type N/A if not applicable(Required) Pediatrician's Name(Required) Pediatrician's Phone Number(Required) A current Certificate of Immunization Form 3231 or a Notarized Affidavit of Religious Objection to Immunization and a Georgia Department of Public Health Form 3300 Certificate of Vision, Hearing, Dental, and Nutrition (Pre-K only) is required with registration. All records are kept confidential.Please upload a copy of the forms listed above. If unable to do so, please make copies and turn into the church office. Drop files here or Select files Max. file size: 64 MB, Max. files: 10. Δ
