super sprouts preschool at christ community united methodist church

Application for admission

A non-refundable registration fee of $30 is required please mail to the church or drop it off at the office. This application and tuition is due by August 1st.  The registration fee will be returned, only if the program is not able to enroll the child) 

Your child must be potty trained by September 1st.

Childs *
Childs
Sex
Date of Birth
Date of Birth
Age as of September 1st
Select Your Class *
Mothers Name
Mothers Name
Address
Address
Cell Phone
Cell Phone
Home
Home
Fathers Name
Fathers Name
Fathers Address if different than mother
Fathers Address if different than mother
Cell Phone
Cell Phone
Home Phone
Home Phone
Can we text you?
Which Phone(s) should we text
1 . Emergency Contact
1 . Emergency Contact
Phone
Phone
2) Emergency Contact
2) Emergency Contact
Phone
Phone
In the event of an emergency and the parents cannot be contacted, do you permit your child to be transferred to Butler Memorial Hospital