Preschool Registration

Marshall United Methodist Preschool

2024-2025 Registration

Student Information

Our school year program begins Tuesday, September 3, 2024. Preschool hours are 8:45am-1:00pm. You will be notified of space availability within a week of signing up. Class assignments, calendars, and supply lists will be available during the summer.

Child's First Name

Nickname

Last Name

Date of Birth

Gender

Female

Male

Child's Address

Has your child had previous daycare or school experience away from home?

Yes

Age of child on September 30, 2024

2 years

3 years

4 years (not going to Kindergarten in 2025)

4 years (going to Kindergarten 2025)

Class Choice

Choose Class (Final class assignments are determined by the Director, this may include a combined ages class (tuition broken down into 9 monthly payments) (The 2's and 3's classes are on a waitlist)

2 year old (Tuesday - Friday) (Waitlist)

2 year old (Tuesday and Thursday) (Waitlist)

2 year old (Wednesday and Friday) (Waitlist)

3 year old (Waitlist)

4 year old

Is your Child completely toilet trained? (requisite for 3/4 year old classes)

Yes

Almost

If you answered No or Almost please explain:

Child's Health Information and History

Health Plan

Group #

Child's Doctor

ID#

Doctor's Phone Number

Are your Child's Immunizations up to date?

Yes

If no please explain

Date of last tetanus shot:

Does your child have any known health problems?

Yes

If yes please explain:

Does your child have any allergies?

Yes

If yes please list allergies, reactions an treatment.

Does your Child get colds/flu often?

Yes

Does your child have any special needs or a family service plan?

Yes

Please Explain:

Please list any serious prior injuries:

Frequent Ear infection or tubes

Whooping Cough

Eczema

Polio

Convulsions

Diphtheria

Frequent Colds

Influenza

Pheumonia

Chicken Pox

Rheumatic Fever

Measles

Does your child take any medication on a regular basis?

Yes

If yes please list the name of the medication(s) and the medical condition for which it is taken:

Does your Child have any speech, hearing, or visual problems?

Yes

If yes please explain:

Has your child been tested for speech, hearing or visual problems?

Yes

Do you have any concerns about your child's development?

Please comment any other medical information/or special need the Preschool should be aware of:

Parent Information

Parent 1

Full name:

Child and Parent have the same address.

Address

Home Phone Number

Work Phone Number

Cell Phone Number:

First contact in case of an emergency

Place of Work, Hours

Marital Status of Parents

Married or Living together

Separated

Divorced

If divorced or separated, please describe any custody and visitation agreements for the child:

Parent 2

Full name:

Child and Parent have the same address

Address

Home Phone Number:

Work Phone Number:

Cell Phone Number:

First contact in case of emergency.

Place of Work, Hours

Names and ages of brothers and sisters

Other adults in the home and their relationship to the child:

Other significant persons in your child's life (step-parents, grandparents, babysitter, etc):

Emergency Contact

Minimum 2 contacts, other than parents, to contact in case of emergency/authorized to pick up child:

Emergency Contact 1 Full Name

Relationship to child

Home Phone Number

Cell Phone Number

Emergency Contact 2 Full Name

Relationship to child

Home Phone Number

Cell Phone Number

Other person(s) authorized to pick up child: Name, Relationship, Phone#

Medical and Emergency Care Authorization

MUMPS will notify the parent when the child becomes ill or is injured and the parent will arrange to have the child picked up as soon as possible. Parents are required to inform MUMPS as soon as possible if the child developes any illness.

I Agree

I authorize MUMPS to obtain the following services for my child if necessary: Public Health Nurse, Physician, Emergency Room, EMS and/or Ambulance transport in the event of an emergency. (Ambulance fees and/or health care costs are the resposibilty of the parent /guardian).

I Agree

I give my permission for my child to participate in the Marshall United Methodist Preschool program and activities. I hereby give my authorization for any emergency medical treatment deemed necessary to the health and safety of my child in the event of accident, illness, or injury, with the understanding that I will be contacted as soon as possible.

I Agree

Parent's Signature

Date

Water Play Authorization

Please be informed that water play can be a high-risk activity and thus permission is required for children to participate in these activities. We may participate in some water activities throughout the year which includes but are not limited to water table, water balloons, and sprinkler. Many precautions will be taken at our facility to help keep children safe when participating in water play.

I authorize my child to participate in ALL water activities offered

I do NOT authorize my child to participate in ANY water activities

Photo Authorization

Photos and videos are taken throughout the school year such as holidays, outings, special occasions as well as in the normal course of our day. We use these photos/videos for teaching, sharing information about the day, arts and crafts, class books, and other things. Photos which may include your child may be given to families who also attend this program or may appear in the newspaper.

I give permission to MUMPS to take photos/videos of my child.

I give permission for photos/videos to be posted online (facebook/Website)

I give permission for photos/videos to be shared with other parents for newsletter

I DO NOT want any photos/videos taken of my child.

My child's Birth Certificate and Immunization Records must be on file before my child can enroll. (You may upload files below, email them, or bring copies to the school

Agree

Upload Documents

I understand that my registration is not complete and my child's space will not be held until I have paid the annual $50 registration fee. You can mail or bring a check to MUMPS. (Address is at the bottom of the page)

Agree

Parent Signature

Date

COVID-19 Policy

Health Form

Parent Handbook

Signature that you have read and agree to the Handbook and COVID-19 Policy *

Parent Signature

Date

Address: 8405 W. Main St. Marshall, VA 20115
Mailing Address: P.O. Box 144, Marshall, VA 20116
Phone: (540) 364-2506

We are so excited for you and child to join our family! We will be in touch soon with more information. Have a blessed day!

Marshall United Methodist Church

8405 West Main Street, Marshall, VA 20115

Open Hearts. Open Minds. Open Doors.

Marshall United Methodist Preschool

2024-2025 Registration

Student Information

Our school year program begins Tuesday, September 3, 2024. Preschool hours are 8:45am-1:00pm. You will be notified of space availability within a week of signing up. Class assignments, calendars, and supply lists will be available during the summer.

Class Choice

Child's Health Information and History

Parent Information

Parent 1

Parent 2

Emergency Contact

Minimum 2 contacts, other than parents, to contact in case of emergency/authorized to pick up child:

Medical and Emergency Care Authorization

Water Play Authorization

Photo Authorization

Signature that you have read and agree to the Handbook and COVID-19 Policy *

Address: 8405 W. Main St. Marshall, VA 20115
Mailing Address: P.O. Box 144, Marshall, VA 20116
Phone: (540) 364-2506

Donations Welcome

Marshall United Methodist Church

Marshall United Methodist Preschool

2024-2025 Registration

Student Information

Our school year program begins Tuesday, September 3, 2024. Preschool hours are 8:45am-1:00pm. You will be notified of space availability within a week of signing up. Class assignments, calendars, and supply lists will be available during the summer.

Class Choice

Child's Health Information and History

Parent Information

Parent 1

Parent 2

Emergency Contact

Minimum 2 contacts, other than parents, to contact in case of emergency/authorized to pick up child:

Medical and Emergency Care Authorization

Water Play Authorization

Photo Authorization

Signature that you have read and agree to the Handbook and COVID-19 Policy *

Address: 8405 W. Main St. Marshall, VA 20115 Mailing Address: P.O. Box 144, Marshall, VA 20116 Phone: (540) 364-2506

Address: 8405 W. Main St. Marshall, VA 20115
Mailing Address: P.O. Box 144, Marshall, VA 20116
Phone: (540) 364-2506