Zion Preschool Enrollment Application If you are human, leave this field blank.Application for Enrollment – SM Zion PreschoolParent/Guardian Name (1) *Parent Guardian (1) OccupationParent Guardian (1) Cell Phone *Parent Guardian (1) Work PhoneParent/Guardian Name (2)Parent Guardian (2) OccupationParent Guardian (2) Cell Phone *Parent Guardian (2) Work PhoneMarital Status *MarriedDivorcedSeparatedSingleFamily Church AffiliationPrimary Phone *Secondary PhoneEmail *Child's Address *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codeChild's Name *SexMaleFemaleBirthdate *Child's Preferred NameKnown Allergy InformationDid this child attend nursery school?YesNoWhere?Are you registering more than one child?YesNoChild #2 NameChild #2 SexMaleFemaleChild #2 Birthday#2 Child's Preferred NameChild #2 Known Allergy InformationDid this child attend nursery school?YesNoWhere?Child #3 NameChild #3 SexMaleFemaleChild #3 Birthday#3 Child's Preferred NameChild #3 Known Allergy InformationDid this child attend nursery school?YesNoWhere?Additional SiblingsPlease 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 RegisterDays Requested & Program Cost2 Days – T + Th ($310 per/month)3 Days – M-W-F ($350/per month)5 Days – ($410/per month)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 RegisterDays Requested & Program Cost2 Days – T + Th ($310/per month)3 Days – M-W-F ($350/per month)5 Days – ($410/per month)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 RegisterDays Requested & Program Cost2 Days – T + Th ($310/per month)3 Days – M-W-F ($350/per month)5 Days – ($410/per month)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 RegisterProgram Cost3 Days – M-W-F ($350/per month)5 Days – $410/per monthPlease 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 RegisterDays RequestedMondayTuesdayWednesdayThursdayFridayHours Requested12PM - 1PM12PM - 2PM12PM - 3PMPlease add requests and/or clarifications here. Before School Care 8am – 9am ($50.00 per month) all ages Before Care Days RequestedMondayTuesdayWednesdayThursdayFridayPlease 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 GuardianUse your mouse to draw your signature on the line below.Reset SignatureCaptcha *reCAPTCHA is required.Submit