St. John’s United Methodist Church Parent’s Day Out/Preschool Enrollment Application        



Child’s Name(s): _________________________________    Birth Date(s):  __________________

   ________________________________                                  __________________

Parents’ Names:  _______________________________________________________________

E-mail Address:  _______________________________________________________________

Home Phone: ____________________________  Cell Phone:    ___________________________



Street                                                          City                                             State/Zip



Room/Rooms (Please circle):      Crib    /    Toddler    /    Preschool    /   Older Preschool

Please indicate which day or combination of days you would like:

1st choice (Please circle):   M    T    W    TH       2nd choice (Please circle):  M    T    W    TH


In order to reserve your child’s place, a $174 per child ($180 Crib room) non-refundable Registration Fee must accompany this form.  The first $124 ($130 Crib room) of that fee goes toward the first month’s tuition.

Please return to: St. John’s Parents’ Day out; 6900 Ward Parkway; Kansas City, MO  64113, on your day of enrollment.

Questions?  Call 816-523-6792 or e-mail:  nbell@stjohnsumc.org.




   Office Use Only:  Paid $ _________  Check # _________ Date ____________