Jasper United Methodist Church Preschool

2022-2023 Application for Admission

Registration Form

Step 1 of 2

Application for Admission

A $75.00 non-refundable registration fee and $35.00 activities fee is due at the time of registration.

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)
MM slash DD slash YYYY
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)
Child's Primary Address(Required)
Father's Name(Required)
Address (if different from child)
Mother's First and Last Name(Required)
Address (if different from child)
Emergency Contacts/Authorized Individuals To Whom Child May Be Released. You may list up to 6 individuals. Please include phone numbers.(Required)
Name
Phone Number
 
click the + sign to add another individual (add up to 6 individuals)