AGAPE Registration 2019-2020

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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 $50/new student or $40/returning student.

All students must be the required age for the class by September 30, 2019 with the exception of the 5-day fours. 5-day students must be 5-years-old by April 30, 2020.

Classes meet on the following weekdays:

Twos: Monday & Wednesday
Threes: Monday, Wednesday & Friday
Fours: Monday, Wednesday & Friday or Monday, Tuesday, Wednesday & Friday or all 5 days

My child is a *

Returning student (returning students have priority placement through January 3rd, 2019)

New student

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 *

2-day twos $215/month

3-day threes $215/ month if co-oping, $250 if not co-oping

3-day fours $205/month if co-oping, $240 if not co-oping

4-day fours $281/month if co-oping, $316 if not co-oping

5-day fours $355/month (no co-op)

Sex *

Male

Female

Date of Birth *

YYYY

Home Phone

Allergies (food, seasonal and environmental)

Home Street Address *

City *

Zip Code *

Mother's First Name *

Mother's Last Name *

Mother's Employer

Mother's Cell Phone *

Mother's Work Phone

Father's First Name *

Father's Last Name *

Father's Employer

Father's Cell Phone *

Father's Work Phone

Special Needs

I understand that AGAPE is predominantly a cooperative preschool. If I enroll my child in a co-op class, I understand that I must co-op approximately once a month to receive the $35 credit. (Type your full name to indicate agreement.) *

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