Enrolling in the summer program at The Preschool at Jenks Church is as simple as 1..2..3!

1. Fill out the form below. Please use the tab button to move between boxes. Click submit when it is completed.

2. Turn in a copy of your currnet shot records and insurance card.

3. Turn in your $30.00 enrollment fee to the Preschool. We are open M-W-F from 9:30-2:30, or you may give it to Mrs. Diane in the church office anytime M-F between 9 and 5.

*Please note that we will put you on our list, but when classes fill up, preference will be given to those who have turned in their enrollment fee.

We look forward to a great summer!


Summer Program 2012 Enrollment Form
Child's name
Date of Birth and grade completed, if applicable
Parent/Guardian
e-mail address
Mom's cell phone
Dad's cell phone
Home phone
Home address
Who is authorized to pick up your child? Please list name and relation.
Is your child allergic to anything?
What do we do in case of accidental exposure?
Other than parents, who do we contact in case of emergency? Please list at least 2 names and phone numbers.
Doctor name and phone number
Dentist name and phone number
Hospital preference
May we photograph your child for preschool and publication purposes?
Yes
No
Additional Comments
How did you hear about our Preschool?