Preschool/Kindergarten Application Weekday Education Application Weekday Education Application for Preschool/Kindergarten Class of Interest: 2 Year/2 Day 3 Year/2 Day 3 Year/3 Day 4 Year/4 Day 5K/5 Day Child's Full Name(Required) Name Called Address(Required) Gender(Required) Date of Birth(Required) First Parent Contact(Required) Mom Dad Name Email Cell Phone Work Phone Employer Second Parent Contact Mom Dad Name Email Cell Phone Work Phone Employer Parents' Marital Status(Required) Married/Living Together Separated Divorced Spouse Deceased Single If divorced or separated: Name of Legal Guardian Describe custody and/or visitation agreement for the child. Please provide proper court documentation regarding custody.Are you an active/pledging member of Smyrna First UMC? Yes No Family's Church Membership/Affiliation, if any Has your child ever received, or is currently receiving services from Babies Can't Wait, any Public School System, or any private therapist for Speech, OT, or Behavior? Yes No If yes, please explain School PoliciesADMISSION and FINANCIAL POLICIES: Smyrna 1st UMC Preschool accepts students without regard to race, creed, sex, religion or national origin. Tuition is based on a child’s commitment to one full school year. If I withdraw my child for any reason prior to the end of school, I must provide written notification to the Director at least 30 days in advance. I understand that paid tuition is nonrefundable except in the event of a family move outside the Atlanta Metro area. Within 48 hours of acceptance into the school, a tuition deposit of $300 is due. ALL $150 tuition deposits are NON-REFUNDABLE under any and all circumstances. The balance of the annual tuition may be paid in 3 equal installments, payable by May 1st, July 15th, and Nov 1st. Please initial that you have read and understand the following policies of Smyrna 1st UMC Preschool/Kindergarten.(Required) I give permission for my family’s name, address, phone number, and email address to be printed and distributed to school parents in the form of a school directory.(Required) Yes No I give permission for my child to be photographed, both individually and as part of a group, by the school staff or designated photographers, and to have these pictures displayed within the school, on the school or church website, on teachers’ classroom websites and in preschool video productions.(Required) Yes No In the event of an emergency requiring immediate medical attention, the Preschool/Kindergarten staff is authorized to consent to such medical treatment for my child as deemed immediately necessary. I understand that health insurance on my child is not the responsibility of Smyrna First United Methodist Preschool and Kindergarten.(Required) Yes No Neither I nor my spouse will hold Smyrna First United Methodist Preschool and Kindergarten liable for any accident, loss, or injury to my child while attending the school or in any function connected with activities of the school, unless such an accident, loss, or injury is caused by negligence, in which case we shall limit any claim or file to no more than the liability insurance coverage of the school.(Required) Yes No Terms and ConditionsSmyrna 1st United Methodist has an exemption from the State of Georgia not to be licensed, because children are not in our facility more than 4 hours a day. The program is a school of Excellence in the North Georgia United Methodist Conference. The Board may require any child to be evaluated by a Board-approved evaluation team, at the parents’ expense, prior to enrollment, or as a condition of continued enrollment. The school reserves the right to suspend the enrollment of any child whose condition or behavior poses a threat to the health, welfare, safety, or education of the other students. All children must have a copy of the child’s birth certificate, a Permission for Healthcare form, an Allergy Action form signed by a physician (if appropriate), and a current Certificate of Immunization (DHR form 3231) on file prior to the start of school. 5K students also require a certificate of vision, hearing, dental, and nutrition screening (form 3300). Each family is expected to volunteer for a minimum of one shift per child at each Kindermart. All students in the 3, 4, and 5K classes must be completely toilet-trained and able to independently use the restroom when school begins. Each child should be wearing underwear, not Pull-Ups, or diapers, at school. For the purposes of clarification, our definition of fully toilet-trained is the child’s recognition of the need to use the restroom, is able to inform an adult of the need to go; enters the restroom on their own; removes necessary clothing with no assistance; sits or stands at the commode and handles own hygiene; re-dresses, washes hands and rejoins the class. By signing below, I agree to abide by all policies, terms, and conditions, as well as periodic revisions to policies and procedures set forth by Smyrna First United Methodist Preschool and Kindergarten in its Parent Handbook as well as through other means of communication. Signature(Required) Date Δ
