2 and 3 yr old Application for Enrollment 2 and 3 year old classes Name(Required) Name your child goes by(Required) Gender(Required) Age as of September 30, 2023(Required) Birthday(Required) MM slash DD slash YYYY Mother's Name(Required) Father's Name(Required) Address(Required) Phone(Required)Dad's Cell(Required)Mom's Cell(Required)Current Student:(Required) Yes No Church Member:(Required) Yes No Sibling Previously Enrolled:(Required) Yes No Please indicate the program in which you wish to enroll your child for 2023-2024 school year2 YEAR OLD CLASS ("2" by Sept 30, 2023) 2 Day class (Tuesday and Thursday 9:30-12:10) $190.00 mo. 2 ½ YEAR OLD CLASS ("2" by March 30, 2023) 2 Day class (Tuesday and Thursday 9:30-12:10) $ 190.00 mo. 2 ½ TO 3 YEAR OLD CLASS ("2" by March 31, 2024, cannot turn "4" before March 31, 2023) 1 Day Class (Friday 9:30 to 12:20) $120.00 mo. 3 YEAR OLD CLASS ("3" by September 30, 2023) 2 Day class (Tuesday and Thursday 9:30-12:20) $190.00 mo. 2 Day class (Wednesday and Friday 9:30-12:20) $190.00 mo. 3 Day class (M-W-F 9:30-12:20) $240.00 mo. *"'Sibling discounts: 10% off second child, 5% for each additional child"""Primary email address where you would like to be reached Any secondary email address where you can be reached Subdivision where child resides Member of St. Mark's United Methodist Church? Yes No Would you like information about St. Mark's United Methodist Church? Yes No Names and locations of all previous attended schools or child care facilities: Does your child have an allergy that requires an epi pen or any other medication? If so, please list the allergens and describe the reaction. Does your child have any medical conditions that the school should be aware of? If so, please explain: Any additional information the school should know about your child: Date of desired enrollment MM slash DD slash YYYY Registration and Activity Fee I am enclosing $150.00 ($100.00 registration and $50.00 activity fee) in payment for the registration fee and the activity fee as required by the school. I understand that neither of these fees apply towards the tuition. Only the activity fee would be refundable if notified by August 1, 2023. September Tuition September tuition is due by May 15th. If tuition is not received by this date, I understand that my child's space may be filled from the waiting list. Withdraw I understand that if I plan to withdraw my child, I need to give the school a month's notice or I will be responsible for paying that month's tuition. Notice needs to be given by August 1st for September tuition to be refunded.Parent Signature(Required) Reset signature Signature locked. Reset to sign again Date(Required) MM slash DD slash YYYY **Explanation of fees** The registration fee holds your child's place and is used to purchase supplies for your child to start the new year. The activity fee funds enrichment programs that enhance your child's preschool educational experience.MEDICAL ALERT: SPECIAL NEEDS CHILDREN St. Mark's Preschool is proud to have a tradition of welcoming special needs children. Some children have easily discernible needs, such as hearing aids or leg braces. Recently, children who are seeking enrollment have less visible needs, such as allergies to foods, the environment, or insect bites. Whereas St. Mark's will do everything possible to create and maintain a safe environment for the students, we are not equipped to handle life-threatening conditions. For this reason, the St. Mark's Preschool requests that each parent determine if the normal, routine safety precautions used for every child is sufficient for your child. For example, the classroom teacher may make every effort to comply with dietary requests, but toddlers and older children may "sneak food" or be offered food by another student while the teacher is busy elsewhere. St. Mark's cannot and will not be responsible for these incidents. Similarly, environmental risks will be monitored to the extent possible, but the general classroom will not be changed to suit the needs of one child to the detriment of others. Therefore, it is up to you, the parent, to decide if your child can safely attend this preschool. ST. MARK'S PRESCHOOL, INCLUDING INDIVIDUAL STAFF MEMBERS, WILL NOT BE RESPONSIBLE FOR ANY ADVERSE CONSEQUENCE TO YOUR CHILD SO LONG AS THE ORDINARY CARE IS PROVIDED, WHICH IS AVAILABLE TO EACH STUDENT. Epinephrine will be the only medication we administer.Parent Signature(Required) Reset signature Signature locked. Reset to sign again RELEASE OF INFORMATION I hereby give my permission for the distribution of my address, email and/or telephone number to other parents of children enrolled in St. Mark's Preschool. I understand home and email addresses and phone numbers will not be given out for any commercial purposes.Parent Signature(Required) Reset signature Signature locked. Reset to sign again PHOTO RELEASE FORM FOR MINORS St. Mark's Preschool 11551 Lucks LaneMidlothian, VA 23114I, being the parent or guardian of(Required) hereby give consent that the photographs or videos taken of him/her during preschool and while he/she is enrolled at St.Mark's United Methodist Church Preschool as a student may be used by St. Mark's United Methodist Church Preschool. These pictures may be used in slideshows, emails, bulletin boards, crafts, preschool brochures, school websites, Preschool Facebook page, etc. When any pictures of students do appear there will not be any personal identification (i.e., student name). Furthermore, I consent that such photographs or videos shall be the property of St. Mark's United Methodist Church Preschool which has the right to duplicate, reproduce, and make other uses as the preschool deems necessary. I understand these photographs and videos may be taken using the school tablet or by a teacher's personal cell phone who has undergone a full background check. These will promptly be deleted from the previously mentioned when the use of the photographs has been completed.Consent I give permission to use my son/daughter's photographs, etc. AS DESCRIBED ABOVE. I DO NOT give my consent to have photographs of my son/daughter used by St. Mark's United Methodist Church IN ANY WAY, as specified above. Name of Student:(Required) DOB:(Required) Signature of Parent:(Required) Reset signature Signature locked. Reset to sign again Street Address:(Required) City, State, ZIP:(Required) Phone(Required)Please sign and return this to the Preschool office. This form will be kept on file in the student's permanent record in the Preschool office. Parents may update or make changes to this form at any time.CAPTCHA Download PDF Here
