AGAPE Registration 2019-2020
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
* Required
My child is a
*
Returning student (returning students have priority placement through January 3rd, 2019)
New student
Child's First Name
*
Your answer
Child's Middle Name
Your answer
Child's Last Name
*
Your answer
All email addresses to which you want communication to be sent
*
Your answer
First Choice Class
*
Choose
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)
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
*
MM
/
DD
/
YYYY
email
Home Phone
Your answer
Allergies (food, seasonal and environmental)
Your answer
Home Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Mother's First Name
*
Your answer
Mother's Last Name
*
Your answer
Mother's Employer
Your answer
Mother's Cell Phone
*
Your answer
Mother's Work Phone
Your answer
Father's First Name
*
Your answer
Father's Last Name
*
Your answer
Father's Employer
Your answer
Father's Cell Phone
*
Your answer
Father's Work Phone
Your answer
Special Needs
Your answer
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.)
*
Your answer
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