AGAPE Registration 2022-2023

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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

My child is a *

Returning student (priority placement through January 7th, 2022)

New student

Sibling (priority placement through January 7th, 2022)

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 *

2-day twos $250/month

3 day day twos $305 /month

3-day threes $305

4- day threes $360

3-day fours Pre-Kindergarten $335

4-day fours Pre-Kindergarten $386

5-day fours/fives Pre-Kindergarten $445

Second Choice Class- if first choice is not available *

2-day twos $250

3 day day twos $305

3-day threes $305

4-day threes $360

3-day fours Pre-kindergarten $335

4-day fours Pre-Kindergarten $386

5-day fours/fives Pre-kindergarten $445

Other:

Sex *

Male

Female

Date of Birth *

YYYY

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. *

Yes

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. *

Yes

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

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