2016 SUMMER REGISTRATION FORM


 

 

St. John’s Parents’ Day Out Summer Session 2017 Registration Form

 

6900 Ward Parkway, Kansas City, MO 64113     (816) 523.6792     nbell@stjohnsumc.org

 

 

 

Child’s Name(s)  ____________________________________        Date of Birth  ________________

  ___________________________________         Date of Birth  ________________

  ___________________________________         Date of Birth  ________________

Parents’ Names: ___________________________________    Email _________________________

Home Phone: ___________________ Cell: ____________________ Work: ____________________

Address:________________________________________________________________________

                           Street                                                          City                              State                  Zip        

 

 

Please circle day/days desired.

 

(*If enrollment is low in each of the Older Preschool and School Age rooms on any given day, these 2 rooms may be combined on that day. Thank you.)

 

Please circle room your child was in this school year.  If new to our program, please note the cut-off birth dates.

 

Crib Room: 1 – 2 years (one by Sept. 1, 2016)           Monday           Tuesday             Wednesday              Thursday

Toddlers: 2 years (2 by December 1, 2016)                Monday           Tuesday             Wednesday              Thursday

Preschool: 3 years (3 by February 1, 2017)                 Monday            Tuesday             Wednesday              Thursday

Older Preschool: 4 years (4 by April 1, 2017)            *Monday           Tuesday             Wednesday              Thursday

School Age: 5 – 7 year olds                                           * Monday           Tuesday             Wednesday              Thursday