AGAPE Registration 2022-2023
Please complete all required fields below.  Your application will be complete when this form is submitted and AGAPE has received your application fee of $100/new student or $75/returning student.

All students must be the required age for the class by September 30, 2022 with the exception of the 5-day Pre-Kindergarten.  5-day students must be 5-years-old by April 30, 2023.

Classes meet on the following weekdays:

Twos:            2 day option-Monday & Wednesday
                      3 day option- Monday, Wednesday, Friday

Threes:         3 day option- Monday, Wednesday & Friday
                      4 day option- Monday, Tuesday, Wednesday, & Friday

Fours:          3 day option - Monday, Wednesday & Friday
                     4 day option-Monday, Tuesday, Wednesday & Friday
                     5 day option

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My child is a *
Child's First Name *
Child's Middle Name
Child's Last Name *
All email addresses to which you want communication to be sent *
First Choice Class *
Second Choice Class- if first choice is not available *
Sex *
Date of Birth *
Home Phone
Allergies (food, seasonal and environmental)
Primary Language Spoken in the home *
Home Street Address *
City *
Zip Code *
Mother's First Name *
Mother's Last Name *
Mother's Cell Phone *
Mother's Work Phone
Father's First Name *
Father's Last Name *
Father's Cell Phone *
Father's Work Phone
Emergency Contact Name (Other than a parent) *
Emergency Contact Phone Number *
Emergency Contact relationship to the student *
Special Needs
I grant AGAPE Preschool permission to take pictures of my child(ren) and display those pictures in the school or crafts. *
I grant permission for individuals associated with AGAPE to take pictures of my child(ten) to be used on the website or promotional material. I understand that photos on website and literature will not identify children by name. *
I have read the AGAPE Parent Handbook and by signing your name below you agree to comply with the information found within. *
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This form was created inside of Gayton Baptist Church. Report Abuse