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Wesley Station Preschool
Application and Registration Form 23-24 School Year
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* Indicates required question
Email
*
Your email
Todays Date
*
MM
/
DD
/
YYYY
Child's Last Name
*
Your answer
Child's First Name
Your answer
choose one
*
Boy
Girl
age as of September 1st, 2023
*
3
4
5
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Preferred or Nick Name
Your answer
Child's Address (Street, City, State, zip code)
*
Your answer
School District which Child Resides
*
Your answer
Mother's Name
Your answer
Father's Name
Your answer
Does either parent have a different address than the child? If so list below.
Your answer
Phone Number #1
*
Your answer
Phone Number #2
Your answer
Parent's email
*
Your answer
2nd Parent's email
Your answer
Mother's Occupation
*
Your answer
Father's Occupation
*
Your answer
Parents' Phone Numbers (Please List 2)
*
Your answer
Number to call first in case of illness or emergency during the school day?
*
Your answer
Student lives with:
both parents
mom
dad
Other:
Clear selection
Other siblings in household; please list ages
Your answer
Health Concerns or Diagnoses
Your answer
Does your child have an IEP?
*
Yes
No
Please list any Allergies
Your answer
Emergency Contact #1 (name, phone number, relationship)
*
Your answer
Emergency Contact #2 (name, phone number, relationship)
*
Your answer
Referred by:
Your answer
Enrollment: 3 year-olds
2 days (Tu/Thu)
3 days (Tu, Th, F)
5 days
Clear selection
Enrollment: 4 year-olds
3 days (M, W, F )
4 days (M-Thu)
5 days
Clear selection
Enrollment: 5 year-olds
4 days (M-Thu)
5 days
Clear selection
Are you signing up for extended day (3 days a week until 2:45)
Yes
Clear selection
I agree to and understand tuition rates.
*
Yes
I understand tuition is broken into 10 payments. The 1st payment is due August 15th, 2023. The 2nd payment is due on May 15th. The other 8 payments are due by the 15th of each month. I understand that I can also pay tuition in full.
*
yes
I understand that policy and behavior contracts will be signed prior to the start of school.
yes
Clear selection
I understand the online registration fee is $78.22
yes
Clear selection
Please type your name
Your answer
Please use
paypal.me/wesleystation
to pay $78.22 registration fee. Don't forget to come back to the form and submit!
Or We can send you an invoice
*
send me an invoice
Send invoice to which email?
Your answer
Comments or questions
Your answer
Send me a copy of my responses.
Submit
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