Alliance United Methodist Church

This page will allow you to begin the registration process for your child from our website. If you have more than one child to register, you will need to submit a registration form for each child. By completing and submitting this form, you will alert the preschool director that you intend to register your child. However your registration is not finalized until your registration and supply fee are paid.

Enrollment is on a first-come, first-served basis. To be sure that your desired class is available, please complete and submit the registration form and send in your fee as soon as possible.

If you would prefer, you may also register by mail or in person by printing out the PDF that is located on this website, filling it out, and submitting it with your registration and supply fee to the preschool. Mailed items should be sent to:

Alliance United Methodist Preschool

7904 Park Vista Blvd.

Fort Worth, Texas 76137

The Registration fee is non-refundable. Supply fee refunds will be made only upon notification of withdrawal before June 30, 2010.

STUDENT INFORMATION

CHILD'S NAME:

PREFERRED NAME:

MALE FEMALE

DOB:

AGE:

CHILD'S AGE ON AUG 1, 2010:

ADDRESS:

CITY:

ZIP:

HOME PHONE:

WORK PHONE:

E-MAIL:

PARENT INFORMATION

MOTHER'S NAME:		FATHER'S NAME:
EMPLOYER:		EMPLOYER:
OCCUPATION:		OCCUPATION:
WORK PHONE:		WORK PHONE:
CELL PHONE:		CELL PHONE:

EMERGENCY INFORMATION

In case of emergency, please notify if unable to contact parents/guardian (Texas State Standards requires 2 people)

Name

Address

Relationship to Child

Name

Address

Relationship to Child

PICK-UP AUTHORIZATION

The following people may pick up my child in addition to the parents and emergency contacts listed above:

Name

Phone

Name

Phone

Name

Phone

MEDICAL INFORMATION

A copy of the child's most recent immunization record must be provided by August 31, 2010.

Please list any allergies your child's reaction (e.g.: milk allergy - stomach ache), prescribed medications, or other special needs or disabilities of which we should be aware:

EMERGENCY MEDICAL AUTHORIZATION

In the event I cannot be reached to make arrangements for emergency medical care at the time of an illness/accident, I hereby authorize the AUMC Preschool Director or her representative to take my child to:

Pediatrician OR Hospital Name, Address, Phone #

Insurance Carrier and ID#

OTHER WAIVERS

PHOTO/VIDEO RELEASE:

Parental/Guardian consent is required if you allow your child to be photographed and/or video taped in the school setting. This media would be used in program slide shows or for display around our building. Occasionally, a photograph may be turned in to the local paper informing people of a special event that has or will be happening at AUMC Preschool. There will be no personal information such as addresses or phone numbers given.

I DO give my consent for my child to be photographed and/or video taped and the media used by AUMC Preschool.

I DO NOT give my consent for my child to be photographed and/or video taped and the media used by AUMC Preschool.

By submitting this form you are agreeing to the Terms and Conditions as set forth by Alliance United Methodist Church Preschool.

I AGREE: