Last:
First:
Gender: FemaleMale
Age of Applicant:
Date of birth:
Place of Birth:
Street
Suite or Apt #
City
State
Zip
Primary Phone#
Email
English Proficiency FluentNeeds AssistanceDoes Not Speak English
Other
Religious Affiliation
Current Member of Central Union Church YesNo
Preschool Preschool Program (3-6 year olds)
Regular Day: 7:30am - 2:30pm I also need Before School Care: 7:00am - 7:30amAfter School Care: 2:30pm - 5:30pm
Ohana Toddler Program 'Ohana Toddler Program (2 year olds)
Morning Program: 7:30am - 11:30am 5 days (Monday - Friday)All Day Program: 7:30am - 2:30pm 5 days (Monday - Friday)
Who recommended Central Union Church Preschool & Kindergarten
I wish to have my child attend Central Union Church Preschool & Kindergarten because
Child lives with Both ParentsMotherFatherOther (please describe)
If child lives with family other than Mother and or Father
How Many Brothers
How Many Sisters
Has No Siblings
Last Name
First Name
Address
Suite Or APT #
Occupation
Employer
Employer's Address
Business Phone
Cell/Pager
Guardian
To the best of my knowledge, this application has been completed with true and accurate information. I understand that supplying false information on any portion of this application may result in the rejection of this application or may result in expulsion from Central Union Church Preschool.Agree
To process your application an application fee of $50 must accompany your application at the time of submission. You will be redirected to Paypal to complete your application. If you prefer to pay with a check, please print and mail the application form along with a check payable to Central Union Church Preschool & Kindergarten.
Print Form
Δ
