Registration Form


Child's name_____________________________________ Sex________ Birth date__________________
Child's address___________________________________ City___________________ Zip___________
Mother's name___________________________________ Home phone____________cell_____________
Mother's address_________________________________ City___________________ Zip___________
Mother's employer________________________________ Phone_________________________________
Father's name____________________________________ Home phone____________cell_____________
Father's address__________________________________ City___________________ Zip___________
Father's employer_________________________________ Phone_________________________________
Other children in your family and their ages____________________________________________________
E-mail address____________________________________
Your child must be 3 or 4 by September 30 and toilet trained to enter the age appropriate half day classes. Your child must be 4 by August 1 with previous preschool experience to enter the Full Day Pre-K class. When this form is received with the non-refundable registration fee of $30, your child's name will be placed on the class roster. Classes will be filled on a FIRST COME BASIS and you will receive notification. Please indicate class preference:
_____ AM Multi-Age Tuesday – Thursday 9:15 to 11:45 $120/mo.
_____ PM Multi-Age Tuesday – Thursday 12:45 to 3:15 $120/mo.
_____ AM 4yr. Pre-K Monday – Thursday 9:15 to 11:45 $140/mo.
_____ PM 4yr. Pre-K Monday – Thursday 12:45 to 3:15 $140/mo.
_____ Full Day Pre-K Monday – Thursday 9:15 to 2:00 $245/mo.
Circle one: YES NO I give consent for Howland Community Church Preschool, LLC to list my name and phone number on a parent roster. I understand that the school will not furnish a roster to any person other than a parent or guardian of a child who attends the Preschool. Phone # to be listed_______________________
It is understood and I agree that since this is a flexible co-operative preschool, participation from a parent/guardian is important to the success of the program. A family member is encouraged to participate about one day a month in the classroom on a rotating basis with the other parents.

Parent's Signature______________________________________________ Date__________________

Mail application and fee to:
HCC Preschool                                                                                       Date application received_______________
198 Niles Cortland SE                                                                         Fee: Church Member $15 Non-member $30
Warren, Ohio 44484                                                                             Enclosed: Check#_______ Cash______
                                                                                                                   Application acknowledged______________