St. Edward
Pre-School – 2007-2008 School Year
A $65.00 non-refundable registration fee must accompany this form.
Child’s Name__________________________________ Birth date: ________________
Address:______________________________________ Sex: ____ Male ____ Female
City/State:____________________________________ Zip Code:_________________
Home Phone: ____________________________ Cell Phone ________________
Father’s Name: __________________________ Work Phone:_______________
Religion: __________________________ Parish:______________________________
Mother’s Name: ____________________________ Work Phone:_______________
Religion: __________________________ Parish:______________________________
Brothers and Sisters:
Name Age School Grade in September
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please check the session(s) you prefer:
Four year old program: ____ Monday, Wednesday, Friday – a.m. (8:30-11:00)
____ Monday, Wednesday, Friday – p.m. (12:00-2:30)
____ Monday, Wednesday, Friday – All Day 8:30 a.m. to 2:00 p.m.
Three year old program: ____Tuesday, Thursday – a.m. (8:30-11:00)
____Tuesday, Thursday – p.m. (12:00-2:30)
Latch key program: ____Mornings from _________to ___________
____Afternoons from ________to___________
OVER
PAYMENT PLAN
Choose One: _____ 10 months from July 1, 2007 to April 1, 2008
_____ 12 months from July 1, 2007 to June 1, 2008
_____ Invoice Monthly _____ Automatically Charge Credit Card
_____ Visa _____ Master Card _____ Discover _____ American Express
Acct. No. ____________________________________ Expiration: _____________
Print Name: __________________________________________________
Signature: __________________________________________________
Date