Call the church office at (509) 926-5407. Summer office hours are Monday-Thursday 8:00-12:00 and 1:00-4:00, Friday 8:00-12:00.
Registration form for 2011-2012
Check Preference:
- Morning class: 9:00-11:30
- Afternoon class: 12:45-3:15
NAME: __________________________________________
BIRTH DATE: _____________________________________
ADDRESS: _______________________________________
ZIP: __________________________
HOME PHONE: _____________________________
CELL PHONE: ______________________________
FATHER'S NAME: ___________________________
MOTHER'S NAME: ___________________________
FATHER'S EMPLOYER: _______________________
MOTHER'S EMPLOYER: ______________________
FATHER'S WORK PHONE: ____________________
MOTHER'S WORK PHONE: ____________________
BABYSITTER'S NAME: ________________________
BABYSITTER'S PHONE: _______________________
BROTHERS/SISTERS NAMES AND AGES: _______________________________________________
In case of emergency notify me or ______________________________ at ______________________
ALLERGIES/MEDICAL PROBLEMS: _____________________________________________________
DOCTOR'S NAME: ______________________________________
PHONE: _____________________
DENTIST'S NAME: ______________________________________
PHONE: _____________________
INSURANCE COMPANY: __________________________
PREFERRED HOSPITAL: _____________
Tuition is due by the 1st of each month. I agree to pay the sum of $135 per month as a monthly tuition fee for my child to attend Zion "Zoo Crew" Preschool. I understand there is a one-time $50 registration fee (non-refundable) to be paid upon registration. I hereby authorize Zion "Zoo Crew" Preschool or whomsoever it designates to take my child while in their company, care, and control to a doctor or hospital of their choice in the event any treatment may be necessary and I cannot be reached. I hereby agree to release Zion "Zoo Crew" Preschool, its members, directors, staff or other supportive groups from any liability as a result of my child being in the care, company and control of Zion "Zoo Crew" Preschool, its members, directors, staff or other supportive groups so long as such injury is not caused intentionally by them.
________________________________________________ Signature
________________________________ Date
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