MCW Preschool Registration
 
Students Name: __________________________________________________________
 
Birth date: Month/Day/Year_______________________________________________­­­__
 
Parent/ Guardian Name: ___________________________________________________
 
Mailing Address: __________________________________________________________
Home Address: ___________________________________________________________
 
Phone Numbers: __________________________________________________________
Second Number: __________________________________________________________
 
Email Address: ___________________________________________________________
 
My student will attend Preschool at what site:  Circle one of the following
Welcome                                             Sherburn                                  Trimont
 
Daycare Name: ___________________________________________________________
 
Daycare Location: ________________________________________________________
 
Days at Childcare: _________________________________________________________
 
Name of ride share families: ________________________________________________
 
Do you need bussing?  (If available) __________________________________________
 
Would you like more information about our Early Learning Scholarships?  __________    (Scholarships are based on MCW free and reduced lunch schedule)
 
Tuition for 2016-2017:  4 year-old program $80.00
                                          3 year-old program $60.00     
 
One month payment:  Date_________________ Check # _____________________
*(your child is not enrolled until payment is received)
Additional comments or special needs: