Zion Preschool Enrollment Application – Saint Miriam Pro Cathedral

Application for Enrollment – SM Zion Preschool

Parent/Guardian Name (1) *

Parent Guardian (1) Occupation

Parent Guardian (1) Cell Phone *

Parent Guardian (1) Work Phone

Parent/Guardian Name (2)

Parent Guardian (2) Occupation

Parent Guardian (2) Cell Phone *

Parent Guardian (2) Work Phone

Marital Status *

Family Church Affiliation

Primary Phone *

Secondary Phone

Email *

Child's Address *

Country

City

State

Zip code

Child's Name *

Sex

Birthdate *

Child's Preferred Name

Known Allergy Information

Did this child attend nursery school?

Yes

Where?

Are you registering more than one child?

Yes

Child #2 Name

Child #2 Sex

Child #2 Birthday

#2 Child's Preferred Name

Child #2 Known Allergy Information

Did this child attend nursery school?

Yes

Where?

Child #3 Name

Child #3 Sex

Child #3 Birthday

#3 Child's Preferred Name

Child #3 Known Allergy Information

Did this child attend nursery school?

Yes

Where?

Additional Siblings

Please list siblings names and ages that you are not registering for preschool here.

Others Living at Home

Toddler Program

15 mos by September 1st

Please Register

Days Requested & Program Cost

Please list some of your child's favorite activities:

What would you like to see your child gain from attending our program?

Two Year Old Program

2 years old by September 1st

Please Register

Days Requested & Program Cost

Please list some of your child's favorite activities:

What would you like to see your child gain from attending our program?

Three Year Old Program

3 years old by September 1st

Please Register

Days Requested & Program Cost

Please list some of your child's favorite activities:

What would you like to see your child gain from attending our program?

Four Year Old and Pre-Kindergarten Program

4 years old by September 1st

Please Register

Program Cost

Please list some of your child's favorite activities:

What would you like to see your child gain from attending our program?

Lunch Bunch/After Care

12pm – 3pm ($7.00 per hour or partial hour) all ages

Please Register

Hours Requested

12PM - 1PM

12PM - 2PM

12PM - 3PM

Please add requests and/or clarifications here.

Before School Care

8am – 9am ($50.00 per month) all ages

Please add requests and/or clarifications here.

*School begins the first week of September each year and is in session until May 31st.

Please Note: Tuition is an annual rate broken down into 9 monthly payments due the first of each month. The rate does not change during months with holidays, absences, etc. The annual rate may be paid in one lump sum. Sibling discount offered at 20%.

After submitting this form, you will be directed to a page where you will have the option to pay the non-refundable registration fee of $50 ($75 per family if more than one child is applying) online. If you wish to pay by check, please remit payment to:

Zion Preschool
654 Bethlehem Pike
Flourtown, PA 19031

Updated 06/14/18

Signature of Parent or Guardian

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