Home Nursery School Registration 2024-2025 Please enable JavaScript in your browser to complete this form.DateCheck #Holy Spirit Member?Holy Spirit Congregation MemberEnrolled?Child/Sibling Previously EnrolledNew EnrollmentSelect Your Class(es) by clicking on your choice(s).(Meets 9:00-11:45/12:30-3:00)First School ExperienceTadpoles (Age 3 by Dec. 31, 2024) - 2 Days (Tues/Thurs AM) - $160.00+fees/monthPollywogs (Age 3 by Dec. 31, 2024) - 3 Days (Mon/Wed/Fri AM) - $195.00+fees/month.Cubs... Getting Ready for KindergartenPanda Bears (Age 4 by Dec. 31, 2024) - 4 Days (Mon/Tues/Wed/Thurs AM) - $235.00+fees/monthBrown Bears (Age 4 by Dec. 31, 2024) - 3 Days (Mon/Tues/Thurs PM) - $195.00+fees/monthPolar Bears (Age 5 by March 1, 2025) - 4 Days (Tues/Wed/Thurs/Fri AM) - $235.00+fees/monthOther Programs For Play and Enrichment (A minimum class size is required to offer some classes)Playful Penguins for ages 3-5 years - 1 Day (Tues or Wed 11:45-2:15) - $25.00/weekPlayful Penguins for ages 3-5d Wed 11:45-2:15) - $50.00/weekYour Child's ProfileName *FirstLastMy child preferrs to be called: *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Email(Will be used for nursery school communication)Primary Contact Number During School Hours *Your Child's FamilyIs English the primary language spoken at home?YesNoIf no, list primary language.Child Lives WithMotherFatherBothGrandparentGuardianOtherIf Other, DescribeIf Parents Are Divorced, Separated, Single, List Any Special ArrangementsPrimary Parental Contact *FirstLastOccupationContact Cell Phone *Email *Address (If different from Child's)Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSecondary Parental ContactFirstLastSecondary Contact OccupationSecondary Contact Cell PhoneSecondary Contact EmailSecondary Contact Home Address (if different from child's)Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOther Members of HouseholdNameAgeRelationshipNameAgeRelationshipNameAgeRelationshipNameAgeRelationshipChild InformationMy child enjoysMy child's relilgious group affiliationAdditional information I'd like to share about my childAll information is confidential and will only be shared with your child's teacher and the school director.Health InformationMedical Conditions:AllergiesDiabetes?DiabetesOther Medical ConditionsMedicationsCurrent in immunizations? *YesNo(If child is not current, a waiver form will need to be completed.)Has your child ever received learning support prior to preschool? (example: speech, physical/occupational therapy)YesNoIf yes, please describe and share current I.E.P.Additional InformationTo complete the registration process, the non-refundable fee ($75.00) must accompany the form. One registration fee is required per child. You can pay via check, or on line after completing this form. Checks should be made payable to Holy Spirit Christian Nursery School. The registration fee holds a spot in a class until June 15th, when the September tuition payment is due. Tuition is a yearly fee and divided into nine payments. The first installment (September tuition) is due on June 15th. This payment will reserve your child's spot in the class. No initial tuition payments are refunded after July 1st. A $25 materials fee is to be paid along with the first tuition payment. I give my permission to share our name, address, phone number and email address with other members of the nursery school community for use in the Nursery School Directory *YesNoSignature of parent or guardianWebsiteSubmit