Please check all applicable boxes:
r JCUMC Church member (due by Jan. 20, 2017)
r Currently enrolled or sibling currently enrolled (due by Jan. 20, 2017)
r Community member (due by February 3, 2017)
Current Families:
The registration fee(s) will be processed in mid-February for current families enrolled in
Tuition Express (TE). If you do not use or want TE charged, please attach a check.
Johns Creek United Methodist Church
11180 Medlock Bridge Road, Johns Creek, GA 30097
770-418-1730 www.JohnsCreekUMC.org
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Kindergarten Application for Admission
2017-18
· The registration fee of $175 is due with application. If your child is placed, this fee is
non-refundable.
· Upon Kindergarten placement, one month’s tuition is due.
· Your last month’s tuition is due by June 1, 2017.
· September and (partial August) 2017 tuition is due by August 15, 2017. Beginning October, tuition will be due by the first of each month, October-March.
· Your October payment will include the annual curriculum/supply fee.
All prepaid tuition is non-refundable.
Child’s Name: Last ______First______Date of Birth:______
( ) Boy ( ) Girl Name used at school:______Home Phone:______
Address: ______City:______State: _____ Zip:______
Subdivision name:______
Parent/Guardian Information:
Dad: Mom:
Last:______First:______Last:______First:______
Cell:______Work:______Cell:______Work:______
Employer:______Employer:______
Email:______Email:______
Marital status: ( ) single ( ) married ( ) separated ( ) divorced
With whom does child reside? ( ) both parents ( ) mom ( ) dad ( ) other______
Active JCUMC member? ( ) yes ( ) no Church Affiliation: ______
Members of Household
Brothers (Names/Ages): ______
Sisters (Names/Ages): ______
Language spoken at home:______
Who in your home speaks and understands English? ( ) mom ( ) dad ( ) child ( ) other______
Child’s General Health and Development
Allergies – including food allergies: ______
List any medical concerns: ______
List any emotional concerns: ______
Program/School(s) previously attended:______
Family Physician: ______Phone: ______
Emergency Contact and Persons Permitted to Remove Child
The following persons may be called for an illness or emergency in the event the parent/guardian cannot be reached. Your child may be released to the individuals you list below. Please include anyone with whom you may be carpooling. For security reasons, your child will not be released to anyone without written permission and photo identification.
Please list in the order you wish persons to be contacted.
( ) mother ( ) father
Name: ______Home Phone:______
Relationship:______Cell Phone:______
Work Phone:______
Emergency contact: ( ) yes ( ) no Pick-up: ( ) yes ( ) no
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Name: ______Home Phone:______
Relationship: ______Cell Phone:______
Work Phone:______
Emergency contact: ( ) yes ( ) no Pick-up: ( ) yes ( ) no *****************************************************************************************************
Name: ______Home Phone:______
Relationship:______Cell Phone:______
Work Phone:______
Emergency contact: ( ) yes ( ) no Pick-up: ( ) yes ( ) no
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I have read and understand the JCUMC Registration Information. By submitting this application, I agree to the terms listed in the brochure and on this application.
Signature______Date______