KING OF KINGS CHURCH
PRESCHOOL / MOM’S DAY OUT REGISTRATION FORM
2013-2014
__________________________
Child’s Last Name
_____________
First Name
______
Middle Initial
__________________
M or F
Date of Birth (mm/dd/yyyy)
Gender
___________________________________________________________
Name your child will use in class if different than listed above (nickname)
___________________________________________________________________
Street Address
City, State
Zip
______________________
Home Phone w/ Area Code
Father’s Name ______________________________________________ Occupation _________________________
Address (if different from child’s) ___________________________________________________________________
Home Phone # (if different from child’s) ____________________________
Work Phone # w/ Area Code ________________________ Cell Phone # w/ Area Code _______________________
Email Address ___________________________________________________________________________________
Mother’s Name ______________________________________________ Occupation _________________________
Address (if different from child’s) ___________________________________________________________________
Home Phone # (if different from child’s) ____________________________
Work Phone # w/ Area Code ________________________ Cell Phone # w/ Area Code _______________________
Email Address ___________________________________________________________________________________
Other Children in the Family
___________________________________ Age _____
___________________________________ Age _____
__________________________________ Age _____
___ _______________________________ Age _____
Child’s Religious Affiliation _______________________________________
Baptized _______Yes _______No
Baptismal Date ___________________________ Church Presently Attending ______________________________
Has your child been enrolled in any other early childhood program prior to this date? ______ Yes _______No
If yes, where? __________________________________________________________________________________
Reason for selecting King of Kings Preschool/MDO? ___________________________________________________
_____________________________________________________________________________________________
How did you hear about our programs?
Church Website
Church
Referral
Facebook
Internet
Other –please specify ________________
Allergies ________ Yes _________ No
If Yes, what are the allergies ___________________________________
______________________________________________________________________________________________
See back for tuition details
Preschool
All classes are morning classes and go from 8:45am – 11:45 am. Please check the appropriate class for the 2013-2014 Preschool Year.
3 Year Olds
(Age 3 by July 31)
4 Year Olds
(Age 4 by July 31)
Pre-Kindergarten
(Age 5 by Dec 1)
____ Monday, Wednesday & Friday
____ Monday, Wednesday & Friday
____ Monday through Friday
____ Tuesday & Thursday
____ Monday, Tuesday, Wednesday, & Thursday
Additional Preschool offerings: Please check all that you will be signing up for:
Extended days (11:45-1:30pm)
____ Tuesdays($40/month) or ____ Wednesdays($40/month)
Extended day information sheets will be distributed in August/Dec. with options for monthly signups.
Beforecare (7:30-8:45am)
____ Same Days as Preschool
2 day program
3 day program
4 day program
5 day program
SEE BELOW FOR CHARGES
Preschool
Per month
$95.00
$125.00
$160.00
$190.00
Beforecare
Per month
$34.00
$51.00
$68.00
$85.00
Mom’s Day Out
_____ Mom’s Day Out
Monday
Tuesday
Wednesday
Thursday
Friday
_____
_____
_____
_____
_____
Early Start 7:30-8:45($4.25/day)
PM session 12:15-3:00($16/day)*
Early Start
Early Start
Early Start
Early Start
Early Start
AM Session 8:45-11:45($16/day)*
All Day 8:45-3:00($33/day)*
_____ AM Session ______ PM Session
_____ AM Session ______ PM Session
_____ AM Session ______ PM Session
_____ AM Session ______ PM Session
_____ AM Session ______ PM Session
______ All Day
______ All Day
______ All Day
______ All Day
______ All Day
*Infant Rates: Early Start ($5.25/day) AM Session ($17) PM Session ($17) All Day Session ($34)
Additional Fees for Both Programs
Registration Fees (Due with Completed Registration Form):
$50 (Non-Refundable) per child (Preschool)
$50 (Non-Refundable) per family (MDO)
Activity Fees (Preschool Only – Due on the 1st Day of School)
3 Year Olds $25
4 Year Olds $40
Pre-Kindergarten $50
Mail to:
King of Kings Preschool
11615 I Street
Omaha, NE 68137
OFFICE USE ONLY
Date Received ____________________
Check # _________________________
EFT Form Received ________________
Entered in Procare ________________
___________ PS
___________ MDO