SAP UMC Community Nursery School

Enrollment Application 2013-2014

www.sapnurseryschool.com 651.647.6385 sapnurseryschool@gmail.com

Enrollment Options (please select one): Morning sessions only 8:55 a.m.-11:30
2 days/week: M/W___ T/Th___ M/F___ 3 days/week: T/W/Th___ 5 days/week:___
$150/mo.

$185/mo.

$255/mo.

Extended day option (11:30-1:30) preferred days: Mon.___Tues.___Wed.___Thurs.___

Student Information:
Name/Nickname:___________________________ Gender: M F D.O.B:________________
Address with zip code (please include a secondary address when applicable):
_____________________________________________________________________________________
_____________________________

Telephone at primary residence: ____________________

Parent Information:
Parent Name: ________________________
Parent Occupation: __________________
Parent Employer: _____________________
Work phone:__________________________

Home phone:_________________________
Cell phone:___________________________
Email:_________________________________
Interests:______________________________

Parent Name: _______________________

Parent Occupation: _________________
Parent Employer: ____________________
Work phone:__________________________

Home phone:_________________________
Cell phone:___________________________
Email:_________________________________
Interests:______________________________

Medical Information:
Doctor/Clinic: _______________________

Dentist/Clinic: _________________________

Address: _____________________________

Address: ______________________________

Telephone: ___________________________

Telephone: ___________________________

Emergency Contact (other than parents)

Contact 1:___________________________
Relationship: _________________________
Address: _____________________________
Telephone:___________________________

Contact 2:___________________________
Relationship: ________________________
Address: ____________________________
Telephone: __________________________

Family Information:
Are both parents living?
_____________________________________
Do the childs parents live in the same
home? Y N

Primary language spoken at home:

______________________________________
Does the child speak English? Y N
Religious preference if any:
_____________________________________
Please list all other people living at home and their relationship to the child:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Social and Emotional Behavior:
Please describe your childs disposition and how they react in different social situations:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Does your child have other school experience?_______________________________________
Does your child have neighborhood playmates?______________________________________
Any learning or social challenges? ___________________________________________________
Home Environment:
Potty trained? Bladder: Y N Bowel: Y N
Name for using the toilet? _____________________ Does he/she signal to go? Y N
Favorite toys and activities? _________________________________________________________
Any habits we should know about?__________________________________________________
Fears or anxiety?____________________________________________________________________
School requirements:
With my signature I request admission into the SAP UMC Community Nursery School for
2013-2014. I understand the $35 registration fee is non-refundable and will not be
returned to me for any reason. Upon acceptance to the school, I will remit a $125
supply deposit to guarantee my childs placement.
I understand that enrollment is for one academic year (September to May) and that
early withdrawal requires a 30 day notice or I will be held responsible for the remaining
tuition.
With my signature, I authorize SAP UMC Community Nursery School to share my childs
name, address, and phone number on the school roster. All other information will be
kept confidential for school use only.
__________________________________________
Signature

___________________________
Date

How did you hear about our program?

_______________________________________________
Are you interested in serving on our Parent Board? ____________________________________
****PLEASE INCLUDE A REGISTRATION FEE OF $35 ALONG WITH THIS APPLICATION****