For Office Use Only: __________
Date Received:_____________
$10 Wait List Fee Rec’d: _____________
ALDERSGATE UNITED METHODIST CHURCH DAY SCHOOL
2015/2016 WAIT LIST APPLICATION
Age of Child on 10/01/15: ____years
months
E-mail Address: ________________________________
Child’s Name: _____________________________________
Last
First
Birthdate: __________________________
MI
Preferred Name: ___________________
Male
□
Month
Female
□
Day
Year
Home Phone: ______________________
Home Address: ___________________________________________________________________________
Street
City
State
Zip
Father’s Name: _______________________________________
Father’s Cell Phone:________________________
Mother’s Name: ______________________________________
Mother’s Cell Phone:_______________________
Father’s Place of Employment: __________________________
Father’s Work Phone: ______________________
Mother’s Place of Employment: __________________________
Mother’s Work Phone: _____________________
Child Resides Primarily with: Mother
□ Father □ Both□
Current or Prior Day School Family? Y
Please indicate if you are an AUMC member: Y □ N□
Church Affiliation: ______________________
Toddler I/Toddler II/Pre-3’s
Threes/Fours/Pre-K
Children not yet three years old on October 1, 2015.
Please indicate your 1st and 2nd choices.
Check One: Toddler I
□
As of Oct 1, 2014: 12-24 months
Toddler II
24-30 months
□
Pre-3
□
30-35 months
How many days per week would you like: ________
(Typical under three enrollment is for two or three days per
week. Please indicate if days are flexible.)
_____ Monday
Monthly Tuition
$ 97
_____ Tuesday
$109
_____ Wednesday
$109
_____ Thursday
$109
_____ Friday
$109
______ Flexible on days
Toddler II and
Pre-3 families
should choose
either T-Th or
M-W-F
□
Three Year Olds
(Children must be three years old by October 1, 2015.)
Monthly Tuition
_____ Two-Days (Tues. & Thurs.)
$186
_____ Three-Days (Mon., Wed. & Fri.) $266
_____ Five-Days
$425
If available would you be interested in a Five-day class? Yes □
Four Year Olds
(Children must be four years old by October 1, 2015.)
_____ Three-Days (Mon., Wed. & Fri.)
_____ Five Days
_____ Pre-Kindergarten
$266
$410
$434
(Pre-K students must be 5 years old before October 1, 2015.)