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Nixon Preschool Registration Form
Register your child for the 2024-25 school year. Please submit a $30 registration fee for your application to be processed (at the end of this form).
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Email
*
Your email
Class for which you are registering:
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M/W/F Pre K: 9:30 AM-12:00 PM Must be 4 years old by September 1, 2024
T/Th Preschool:9:30 AM- 12:00 PM Must be 3 years old by September 1, 2024
Child's First Name
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Your answer
Child's Middle Name
*
Your answer
Child's Last Name
*
Your answer
Does your child go by a nickname that you prefer we use on labels and such?
*
Your answer
Has your child previously attended a preschool program?
No
Yes
Clear selection
Child's Birthdate:
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MM
/
DD
/
YYYY
Child's Address
Street:
City:
Zip Code:
*
Your answer
Mother's Contact Information
Address:
Phone Number:
Place of Employment:
*
Your answer
Father's Contact Information
Address:
Phone Number:
Place of Employment:
*
Your answer
If child's mother or father do not have legal guardianship, please list the name, address, phone number of child's guardian.
Your answer
Please list any siblings and their ages:
Your answer
Do you give permission for us to use your child's photograph on social media (Facebook)? We often post pictures in our public and private groups to showcase what we are doing in preschool.
Yes
No
Clear selection
Emergency Contacts:
Please list in order (excluding parents) 3 people we can contact in case of emergency. Please include a phone number for each contact.
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Your answer
Excluding parents, who else do you give permission to pick your child up from school?
*
Your answer
Does your child have any food allergies?
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Your answer
Does your child have any health restrictions?
*
Your answer
In case of emergency and parents are unable to be contacted, do you give permission for your child to be transported to nearest hospital:
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Yes
No
By typing your full name below, you agree to pay the following tuition by the 5'th of each month (9 payments total):
M/W/F Class: $120/month
T/Th Class: $100/month
*
Your answer
How did your hear about Nixon Preschool?
Your answer
Finally, please submit your $30 registration fee. You can mail a check to the school (334 Airport Rd. Butler, PA 16002) or follow the link to submit your payment online. If paying online, please add a $3 fee. Once you click on the link, click on the green "Give" button.
https://nixonumc.weebly.com/preschool.html
*
I submitted my payment online.
I will mail a check to the preschool.
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