Preschool & Kindergarten 2021-2022 Registration

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CLICK HERE to view the MSDH Parent Regulation Summary.

CHILD'S INFORMATION

* Indicates required field

Child's Full Name *

First

Last

Name Child Goes By *

Date of Birth *

Names and Ages of Siblings *

Address *

Address Line 2 *

City, State, Zip Code *

MEDICAL INFORMATION

Child's Primary Care Physician *

Phone Number *

List any special needs or medical history. *

Please list any medications your child takes on a regular basis. *

Please list any allergies. (Please bring a doctor’s statement for food allergies.) *

Please list any other information you feel we need to know about your child, including nap schedule, security aids, feeding schedule. *

PARENTAL INFORMATION

Does the child live with both parents? *

Yes No

If no, list with whom the child lives and the marital status of that parent: *

Mother's Name *

First

Last

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Mother's Cell Number *

Mother's Email *

Mother's Church Affiliation *

Mother's Place of Employment *

Mother's Work Number *

Father's Name *

First

Last

Father's Cell Number *

Father's Email *

Father's Church Affiliation *

Father's Place of Employment *

Father's Work Number *

CLASS SELECTION

Child must be of age by September 1.

I wish to enroll my child in: *

Infant (3-12 months) Tuesdays & Thursdays; 9 a.m. – 2 p.m. Play School (Toddlers 12-24 months) Tuesdays & Thursdays; 9 a.m. – 2 p.m. Pre-School (2-Year-Olds) Tuesdays & Thursdays; 9 a.m. – 2 p.m. Preschool (3-Year-Olds) Tuesdays, Wednesdays, & Thursdays; 9 a.m. – 2 p.m. Preschool (4-Year-Olds) Mondays-Thursdays; 9 a.m. – 2 p.m. Kindergarten; Monday-Thursday; 9 a.m. – 2 p.m. & Friday 9 a.m. – 12 p.m.

PERMISSIONS

My child may be photographed at FUMC Preschool. *

Yes No

My child's photograph may be posted on the Preschool and Church Social Media & Website. *

Yes No

My child may take approved field trips sponsored by FUMC Preschool. *

Yes No

My child may be given medications with parental permission. *

Yes No

The FUMC Preschool may give my child emergency medical treatment if needed. *

Yes No

My child is toilet trained: *

Yes No

If no, a conference will be scheduled for certain age children.

EMERGENCY CONTACT

In case of an emergency and the PARENTS cannot be reached, contact the following people

Name *

First

Last

Relationship to Child *

Phone Number *

Name *

First

Last

Relationship to Child *

Phone Number *

Name *

First

Last

Relationship to Child *

Phone Number *

Name *

First

Last

Relationship to Child *

Phone Number *

The following people have permission to pick my child up from school: *

I have been given and have read a copy of the MSDH Parent Regulation Summary. *

Yes No

See link at the top of this page.

I agree to pay fee on the first of each month or as agreed upon. *

Yes No

Submit

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CHILD'S INFORMATION

MEDICAL INFORMATION

PARENTAL INFORMATION

CLASS SELECTION

PERMISSIONS

EMERGENCY CONTACT

Come see us:

Contact Us

662-690-8100412 WEST MAIN STREET - TUPELO, MS 38804PO BOX 854 - TUPELO, MS 38802

662-690-8100
412 WEST MAIN STREET - TUPELO, MS 38804
PO BOX 854 - TUPELO, MS 38802