Culpeper UMC Preschool

CUMC HOMEPAGE

ABOUT US

APPLICATION FOR ADMISSION

Please fill out this application in its entirety. Once submitted, you will be directed to the online bill pay where you can remit payment for the registration fee. The non-refundable enrollment fee is $75.00 ($60 for Early Bird Enrollment, between the dates of Feb 10-Feb 25). You may also submit a check made out to CUMC Preschool.

Culpeper United Methodist Church Preschool does not discriminate against any student on the basis of race, creed, or national origin.

Child Enrollment/ Information Record

Child's First Name

Child's Middle Name

Child's Last Name

Date of Birth

Please check desired program (student must be age of desired class by September 30, of the current year, and potty trained). PLEASE NOTE: Availability of the 2-day and 5-day three-year-old program may change based on enrollment.

2-Day Three-Year-Old Preschool (Choice of two days, 9am-12pm) $250 per month

3-Day Three-Year-Old Preschool (Monday, Wednesday, Friday, 9am-12pm) $375.00 per month

5-Day Three-Year-Old Preschool (Monday-Friday, 9am-12pm) $550.00 per month

5-Day Four-Year-Old Pre-K (Monday- Friday, 9am-12pm) $550.00 per month

I am interested in early drop off (8:30am)

Preferred Name/Nickname

Child's Home Address/ Contact Information

Child's Home Address

Phone

Email (primary)

Email (secondary)

Parent/Guardian Information

Mother's First and Last Name

Home Phone

Cell Phone

Address (if Different than above)

Employer

Father's First and Last Name

Home Phone

Work Phone

Cell Phone

Address (if Different than above)

Employer

Work Phone

Medical Information

Child's Physician

Child's Dentist

Phone Number

List all allergies, including food and medical

Any chronic physical and/or emotional problems or conditions

Emergency Contacts (local contacts only, please) If parents/guardians can not be reached

Name

Address

Name

Address

Relationship

Phone

Relationship

Phone

Name and Phone Numbers of persons authorized to pick up your child

(may be the same names as above)

Name

Relation

Phone

Does your child have any special medical, behavioral, etc issues?

Other Preschools your child has attended

Has your child ever been asked to leave a preschool?

Are you a member of CUMC?

How did you hear about CUMC Preschool?

Important Information for Parents

Enrollment Policy: Children who are enrolled but not toilet trained at the start of school will not be accepted. Enrollment fees will not be refunded if your child is not toilet trained by the first day of school. At parents’ request, we can place the child on a waiting list at no cost until they are properly toilet trained.

Enrollment fees are also not refunded if you choose not to send your child to this school.
The two and five day three-year-old program is subject to staffing and enrollment numbers. It is possible these program options may be become unavailable before the start of the year. The school will let you know as soon as possible if this is the case.

Wait List: Depending on enrollment numbers and staffing, it is possible that your child may be put on a waitlist. Our school has a legal capacity limit and staff-student ratios that need to be taken into consideration. We will let you know immediately if your child is put on the waitlist, and he/she will be accepted off the waitlist in the order of application date.

Tuition Policy: The school year’s tuition is based on a monthly rate and is collected in nine equal payments (September-May). Each payment is due no later than the fifth of each month, unless other arrangements have been made with the director. Tuition is considered late after the 10th of the month and may be subject to a late fee. There is no deduction for absences, holidays, or snow days. Checks should be made payable to CUMC Preschool, or you may pay on our secure preschool webpage.

Curriculum Fee: There will be a non-refundable curriculum fee of $130.00 due by August 1, prior to the start of the current school year.

Parent Signature

Today's Date