PRESCHOOL AND ENRICHMENT PROGRAM

FIRST UNITED METHODIST CHURCH

1589 W. MAPLE ROAD

BIRMINGHAM, MI  48009

646-4889

Please fill in the information below and attach your non-refundable  Registration Fee.

LAST                           FIRST                          NAME TO BE CALLED IN SCHOOL

PHONE NUMBER:  __________________________CELL ______________________

HOME ADDRESS:  ______________________________________________________

                                    NUMBER/STREET                             CITY                           ZIP

BIRTH DATE:  ________________________       SEX:    MALE                 FEMALE    

                                    DR.

FATHER’S NAME:   MR.___________________________________________

                                                LAST                           FIRST

                                     DR.

MOTHER’S NAME:  MRS.__________________________________________

                                                LAST                           FIRST

CHILDREN IN FAMILY WHO HAVE ATTENDED OUR SCHOOL:  _____________

PREVIOUS SCHOOLS CHILD ATTENDED:  _________________________________

CLASS CHILD WILL ATTEND:  THREE YR. OLD – TUES/THURS A.M.  ________

                                                         FOUR YR. OLD – MON/WED/FRI A.M.  ________

                                                         FIVE YR OLD ENRICHMENT M-F P.M. ________

MEMBER OF FIRST UNITED METHODIST CHURCH:      YES            NO

REGISTRATION FEE:    FUMC CHURCH MEMBER     $200   ____________

      NON MEMBER                          $250   ____________

CHILDREN MUST BE TOILET TRAINED BEFORE STARTING SCHOOL IN SEPT.

I HEREBY ENROLL MY CHILD IN THE FIRST UNITED METHODIST PRESCHOOL AND ENRICHMENT PROGRAM AS A STUDENT FOR THE 2008-2009 SCHOOL YEAR.  I UNDERSTAND THAT I WILL BE RESPONSIBLE FOR ALL NON-REFUNDABLE TUITION PAYMENTS DUE JULY, SEPTEMBER , NOVEMBER AND FEBRUARY.

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SIGNATURE                                                              DATE