2017-18 Stephens City United Methodist Preschool Registration Form
Please fill out the following form. If you have any questions please call the preschool office at 540-869-1368 or email stephenscitypreschool@gmail.com

A $50.00 registration fee must be submitted to Stephens City United Methodist Preschool In order to complete registration for the 2017-18 school year. Registration is not guaranteed until the $50.00 registration fee is received. The registration fee can be dropped off at the Preschool Office or mailed to Stephens City United Methodist Preschool at P.O. Box 428, Stephens City, VA 22655.

Email address *
Name of Child *
(Last, First, Middle Initial)
Your answer
Parent/ Guardian Name(s) *
First and Last Name
Your answer
Date of Birth *
Month/ Date/ Year
Your answer
Student Gender *
Required
Parent/ Guardian Home Phone Number *
Your answer
Parent/ Guardian Cell Phone Number *
Your answer
Additional Phone Numbers
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Additional Email Addresses *
Your answer
Preschool Program of Choice *
Required
Please mark your enrollment preference. Please enter your second choice in the "Other" box. *
We will try our best to give your your 1st preference. However, due to the number of classes available we may need to go to your next choice.
Required
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