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Covenant Developmental Preschool Registration Form
Reserve your child's space today!
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* Indicates required question
Email
*
Your email
PARENT CONTACT INFO
Parent 1 Name (First and Last)
*
Your answer
Parent 1 Email Address
*
Your answer
Parent 1 Phone Number
*
Your answer
Parent 2 Name (First and Last)
*
Your answer
Parent 2 Email Address
*
Your answer
Parent 2 Phone Number
*
Your answer
PRIMARY ADDRESS
Street Address
*
Your answer
City
*
Your answer
State
*
VA
Other:
CHILD INFO
Child's Name (First and Last)
*
Your answer
The name my child should be called is:
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Current Age
*
One Year Old
Two Years Old
Three Years Old
Four Years Old
Five Years Old
Other:
PROGRAM OPTIONS
Which program would you like to enroll?
*
Preschool 1: Monday & Wednesday
Preschool 1: Tuesday & Thursday
Preschool 2, Three Day: Tuesday - Thursday
Preschool 2, Four Day: Monday - Thursday
Pre-K, Four Day: Tuesday - Friday
Pre-K, Five Day: Monday - Friday
Would you like to add Extended Day?
Extended Day pickup is at 3:00 PM
Extended Day Options
*
Yes: Extended Day (Monday - Thursday)
Yes: Partial Extended Day (Same two days each week)
No Extended Day for us, thanks!
REGISTRATION FEE
Your child's spot will be reserved when the registration fee is received.
The registration fee is $100.
You can pay online.
You can mail a check.
You can swing by and drop off a check.
There will be instructions in the confirmation email about how to pay the registration fee.
I plan to:
*
Pay my registration fee online (instructions will be in the confirmation email).
Drop off a check at Covenant Presbyterian Church, 2001 N. Coalter Street, Staunton, VA 24401
Mail a check to Covenant Presbyterian Church; Attn: Mitzi White; PO Box 2948, Staunton, VA 24402
A copy of your responses will be emailed to the address you provided.
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