School Age Student Registration- January 2021
Madison Street Preschool
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Student Name *
Student birth date *
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Student's Current Grade *
Student's School *
Our School Age Program is only open to the children of Madison Street UMC Staff, siblings of current preschool students, and church members.  Does this student meet this criteria? *
Please indicate which criteria you are enrolling under: *
Does the student have any allergies that we need to be aware of? *
Please describe any allergies or health issues that the staff at Madison Street Preschool need to be aware of: *
Parent names: *
Address: *
Phone Number: *
Please list emergency contact name and contact number for anyone we may need to contact (other than parents listed above) *
Do you agree to supply the staff of Madison Street Preschool with all materials and CMCSS supplies that your child will need to complete remote learning school work and/or ZOOM class meetings while your child is in the care of MSP? (Church Wifi will be utilized, so CMCSS hotspots are not needed.) *
By registering your child for our School Age program, you agree that your child will attend Madison Street Preschool on Tuesday & Thursday, January 12/15 and January 19/21, 2021.  (If CMCSS remote learning is extended beyond the current return date of January 25, our program will be extended.)  Your registration is an acknowledgement of a commitment to pay $40 per week per child for this programming for school age children, as well as a verification that your family acknowledges and agrees to abide by all current MSP and MSUMC COVID-19 protocols and procedures.   *
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