St. John's Preschool Registration

Please fill out this form and click submit.

Child's Name

*

Class to be enrolled in:

*

Please select all that apply.

Pre-K All Day M-F (Must be 4 yrs by Sept 1) $405/month Pre-K All Day M/W/F (Must be 4 yrs. by Sept 1) $245/month M/W/F AM (Must be 4 yrs by Sept 1) $105/month T/TH AM (Must be 3 yrs by Sept 1 & potty-trained) $90/month

Date of Birth

*

Baptized

*

Please select one option.

Yes No

Sex

*

Please select one option.

Male Female

Allergies

*

Medications

*

Do you have any concerns about your child's:

Please select all that apply.

Physical Development Language Development Social Development Emotional Development Behavior

Please check if your child has received any of the following services;

Please select all that apply.

Speech Vision Hearing Physical Therapy Birth to 3

Home Address

*

Parent(s) Name(s)

*

Email

*

This address will receive a confirmation email

Primary Phone

*

Check all that apply

*

Please select all that apply.

Cell Home Texting

Other Phone numbers (other spouse, home, etc.)

Mother's Employer and Phone #

Father's Employer and Phone #

Siblings (Name/Age)

Church Attend

*

Referred by:

Payment $40

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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