19

---

ehills preschool registration form 2018/19

Please print and complete

Child’s Full Name_______________________________________________________________________ Gender Male/Female Birth Date________________________ Age _____ Other siblings enrolled at EHCC Preschool____________________________________________________ Known Allergies________________________________________________________________________ Home Address ________________________________________________________________________ City_________________________ State ________ Zip Code ___________ Contact Email _________________________________________________________________________ Mother/Legal Guardian __________________________________________________________________ Home Address_________________________________________________________________________ City __________________________ State ______ Zip Code____________ Mother’s Contact Phone # hm _____________ cell ____________________ Father/Legal Guardian __________________________________________________________________ Home Address (if different) ______________________________________________________________ City ________________________ State ________ Zip Code__________ Father’s Contact Phone # hm _____________ cell ____________________ Are you a regular attendee at Eastern Hills Community Church? YES/NO Are you affiliated with another church? YES/NO If yes, which one? __________________________________________________________ Current Program Options ​(Please circle your first and second program choices)

Playschool (2 yrs old by 9/1) Preschool (3 yrs old by 10/1) AFTERNOON Preschool (3 yrs old by 10/1) Pre-Kindergarten (4 yrs old by 10/1) AFTERNOON Pre-Kindergarten (4 yrs old by 10/1) Jr. Kindergarten (5 yrs old by 11/15) AFTERNOON Jr. Kindergarten (5 yrs old by 11/15) TUITION: PLAYSCHOOL 2 DAYS 3 DAYS 4 DAYS

$195 $172 $258 $344

1​st​ PROGRAM CHOICE

2​nd ​PROGRAM CHOICE

​M/W

T/TH

M/W

T/TH

M/W/F

T/TH

M/W/F

T/TH

T/W/TH M/W/F

T/W/TH T/TH ​

​M-TH

​M/W/F

​M-TH

M-TH

M-TH

M-TH

​M-TH

M-TH NON-REFUNDABLE REGISTRATION FEES

T/TH

$100 $125

​M-TH

PLAYSCHOOL/ PRESCHOOL/ PRE-K & JK

MORNING SESSION 8:45am - 11:45am AFTERNOON SESSION 12:15pm - 3:15pm *To ensure enrollment for each class, September tuition is due by August 1. Non payment will result in loss of Subsequent tuition payments will be due the 1st ​ ​ of the month, September thru April _______ (Please initial) For Office Use Only: cash check card (ck#______________)

​

enrollment.