Columbia Heights
Preschool
775 Galloway Road, P.O. Box 327
Galloway, Ohio 43119
614-778-3738
Registration Form 2011-2012
ALL CHILDREN MUST BE TOILET TRAINED
Today's Date ___________Child's Name _______________________________________________________________ Birthdate ________________
Name you want your child to learn to spell this year _________________________________ Male/Female_____________
Address ___________________________________________________________________ ZipCode _________________
Mother's Name __________________________________________________ Email ______________________________
Mother's Address ________________________________________________ Home Phone ________________________
Mother's Employer _______________________________________________ Cell/Work # _________________________
Father's Name __________________________________________________ Email ______________________________
Father's Address ________________________________________________ Home Phone ________________________
Father's Employer _______________________________________________ Cell/Work # _________________________
Others in home (Names, ages & relationship. If former students, please list years attended.)
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
CLASS CHOICE
Note:Enrollment is open to all 3, 4 and 5 year-olds whose birthday is on or before September 30th of the year of enrollment.
3 YEAR OLDS ____ Monday/Wednesday/Friday 9-11:30 AM
3 YEAR OLDS ____ Monday/Wednesday 12:30-3:00 PM
3 YEAR OLDS ____ Tuesday/Thursday 9-11:30 AM
4-5 YEAR OLDS ____ Monday/Wednesday/Friday 9-11:30 AM
4-5 YEAR OLDS ____ Monday/Wednesday/Friday 12:30-3:00 PM
4-5 YEAR
OLDS
____ Tuesday/Thursday 9-11:30 AM
Children currently enrolled in preschool will have first preference for classes the following year until May 30. After that date, openings will be given on a first come, first serve basis. You will be notified by phone if you do not receive your first choice.
I wish to make an application to enroll my child in Columbia Heights Preschool program. Enclosed is a check/money order for $50.00 for the resgistration fee. This FEE IS NON-REFUNDABLE. First month's tuition will be due at the Parent Orientation meeting in August.
PARENT SIGNATURE(S)____________________________________________________________ Date __________________
How did you hear about us? Friend __________ Messenger __________ Website __________ Columbus Parent __________
Other (describe)____________________________________________________________________
Please make checks payable to Columbia Heights Preschool.
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For Office Use Only
Date Rec'd Check # $Amount
Application Form __________ __________ __________
September Tuition __________ __________ __________
ANY QUESTIONS EMAIL US AT: chpreschool@hotmail.com