A Non-refundable application fee must be submitted with this form in order to reserve student placement.  

  $100.00 for pre K 4

  $50.00 for pre K 3 and pre K 2

*For returning students- this will be put towards first month’s tuition*

Child Information:

First name:____________________________ MI ____ Last name ____________________________  Gender:  M   /   F

Name child prefers to be called: ________________________Date of birth: __________  Age at time of application: ___

Address: ______________________________________________________________________________

Allergies/Special Alerts:___________________________________________________________________

______________________________________________________________________________________

        I have submitted an updated copy of my child’s immunization record along with this completed registration form.

(*Note: Required prior to participation in this program)        

Parent/Guardian Information:

Mother/Guardian: First name: _____________________________ Last name: ________________________________

Address: _____________________________________________________________________

Home phone: (       )_________________Cell phone: (       )___________________ E-Mail: _____________________

Employer: ____________________________________________  Work Phone: ______________________________

Father/Guardian: First name: ______________________________  Last name: _______________________________

Address: ________________________________________________________________________________________

Home phone: (       )___________________Cell phone: (       )______________________E-Mail: ___________________

Employer: ____________________________________________  Work Phone: ________________________________

Emergency Contacts:

First Contact: Name: ______________________ Daytime phone: (      )_________________ Relation: ______________

Second Contact: Name: ______________________ Daytime phone: (      )_________________ Relation: ____________

____________________________________________________________________________________________

Signature                                                                                                                                                   Date

Photo Release Form

Please be advised that your child may be photographed and/or videotaped in classroom or school related activities.  We may use these photos/videos on our Facebook page, Website, and any other printed public literature (ex. brochures) relating to First Steps at Little River United Methodist Church.   We never use the child’s name with the photograph.  Please indicate your permission to use your child’s photograph by checking the appropriate box below and signing.  

Thank you!

     I grant Little River United Methodist Church (LRUMC) the right to take photographs/video of my child in connection with First Steps Children’s Ministry.  I authorize LRUMC, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

_______________________________________________________Parent/Gardian Signature

     I do not give permission for Little River United Methodist Church First Steps Children’s Ministry to photograph/videotape my child for use on their Facebook page, Website or any other printed public literature.

______________________________________________________Parent/Gardian Signature