For Office Use Only: ______
Date Received:______
$10 Wait List Fee Rec’d: ______
ALDERSGATE UNITED METHODIST CHURCH DAY SCHOOL
2017/2018 WAIT LIST APPLICATION
Age of Child on 10/01/17: ____years months E-mail Address: ______
Child’s Name: ______Birthdate: ______
Last First MI Month Day Year
Preferred Name: ______Male □ Female □ Home Phone: ______
Home Address: ______
Street City State Zip
Any special requests or information regarding your child you would like to discuss with the Director? Y □
(You may describe on the back of this form. Please note we DO NOT take specific teacher requests, however, you are welcome to describe a particular environment that may suit your child best.
Father’s Name: ______ Father’s Cell Phone:______
Mother’s Name: ______ Mother’s Cell Phone:______
Father’s Place of Employment: ______ Father’s Work Phone: ______
Mother’s Place of Employment: ______ Mother’s Work Phone: ______
Child Resides Primarily with: Mother □ Father □ Both□ Current or Prior Day School Family? Y □
Church Affiliation: ______Please indicate if you are an AUMC member: Y □ N□
For Office Use Only: ______
Date Received:______
$10 Wait List Fee Rec’d: ______
Toddler I/Toddler II/Pre-3’s
Children not yet three years old on October 1, 2017.
Check One: Toddler I □ Toddler II □ Pre-3 □
As of Oct 1, 2017: 12-24 months 24-30 months 30-35 months
How many days per week would you like: ______
(Typical under three enrollment is for two or three days per week. Please indicate if days are flexible.)
Monthly Tuition
_____ Monday $107
_____ Tuesday $120
_____ Wednesday $120
_____ Thursday $120
_____ Friday $120
______Flexible on days
Threes/Fours/Pre-K
Please indicate your 1st and 2nd choices.
Three Year Olds
(Children must be three years old by October 1, 2017.)
Monthly Tuition
_____ Two-Days (Tues. & Thurs.) $220
_____ Three-Days (Mon., Wed. & Fri.) $288
_____ Five-Days $445
Four Year Olds
(Children must be four years old by October 1, 2017.)
_____ Three-Days (Mon., Wed. & Fri.) $285
_____ Five Days $436
_____ Pre-Kindergarten $456
(Pre-K students must be 5 years old before October 1, 2017.)
For Office Use Only: ______
Date Received:______
$10 Wait List Fee Rec’d: ______
NOTE: The Day School will be increasing its school year by four days to align with the earlier FCPS start date.