Nursery School Registration Form
Children MUST be 3 years old and potty trained in order to apply.

Registration fee (non-refundable) of $35.00 must be sent (& checks payable) to:
Central United Methodist Preschool, 205 11th St., Honesdale, PA 18431

Child's Name *
Your answer
Child's Date of Birth *
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/
DD
/
YYYY
Father's Name *
Your answer
Mother's Maiden Name *
Your answer
Home Address *
Your answer
Email Address *
Your answer
Home Phone Number *
Your answer
Emergency Phone Number *
Your answer
Any Medical Conditions *
Your answer
Allergies *
Your answer
Right or Left Handed *
Your answer
Work Address *
Your answer
Work Phone Number *
Your answer
Church of Your Choice *
Your answer
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