<p> ARAPAHO UNITED METHODIST CHURCH DAY SCHOOL ENROLLMENT FORM FOR 2013 - 2014 SCHOOL YEAR</p><p>Check Class Preference: Enrollment fee Supply Fee due 8/1 Tuition due 1st day of school  2 day class (2½, 3, yng. 4) (8:45 - 11:45) $130.00 $100.00 $120.00 per month  3 day class (2½, 3, yng. 4) (8:45 - 11:45) 130.00 150.00 155.00 per month  5 days (2½, 3, yng. 4) (8:45 – 11:45) 235.00 250.00 275.00 per month  2 day class (PreK ) * (8:45 – 11:45) 130.00 100.00 125.00 per month  3 day class (PreK) * (8:45 - 11:45) 130.00 150.00 160.00 per month  5 day (PreK) * (8:45 - 11:45) 130.00 250.00 240.00 per month  Pow Wow (11:45 - 2:00) Registration in August 9.00 per day</p><p>* PreK is designed for children age 4 - 5 years who will go to Kindergarten in Fall, 2014. ______Child’s Name child Full Name:______is called by:______</p><p>Birthdate: mo __ __/day__ __/yr____ Age on 9/1/13 yrs mos Sex:______</p><p>Address:______City & Zip:______</p><p>E-mail (optional):______Phone:______</p><p>Father’s name:______Mother’s name______</p><p>Place of employment:______Place of employment:______</p><p>Occupation:______Occupation:______</p><p>Business phone______Business phone:______</p><p>Cell phone______Cell phone:______</p><p>Names & ages of siblings:______</p><p>School district you live in:______Church affiliation:______</p><p>Doctor’s name:______Phone:______</p><p>Doctor’s address:______</p><p>˃ Please provide the following information; use back of form for additional explanation or contacts. Statement of Child’s Special Concerns / Needs: includes premature birth, allergy, existing illness, previous serious illness / injury, hospitalizations in the last 12 months, any medication prescribed for long-term, continuous use. (indicate “None Known” or explain.______</p><p>(Other than parents) Person to call in Name:______Phone:______an emergency: Address______Relationship______</p><p>Persons my Name:______Address:______Phone:______child may be released to: Name:______Address:______Phone:______</p><p>I understand that acceptance of this Enrollment Form and Fee assures my child a place in the school. I also understand that the Enrollment Fee is not refundable after June 1, 2013. I will notify the school of any changes in enrollment plans for my child. Date:______Signature of Parent or Guardian:______</p><p>Office Use Only: Fee Pd. & Date______Date of first admission______Director’s Signature______</p>