Date

MM

DD

YYYY

Name of Child 1: *

First Name

Last Name

Name of Child 2:

First Name

Last Name

Name of Child 3:

First Name

Last Name

Child #1 DOB

MM

DD

YYYY

Child #2 DOB

MM

DD

YYYY

Child #3 DOB

MM

DD

YYYY

Gender

Male

Female

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Mother's Name *

First Name

Last Name

Father's Name

First Name

Last Name

PMO/Toddler's Class ( 6-24 months)

Weekly Tuition Rates, charged monthly

2 days: Tuesday and Thursday ($230)

3 days: Mon, Wed, Fri ($335)

5 days: Monday - Friday ($510)

2 year old Class

Monthly Tuition Rates

Tuesday and Thursday ($215/month)

Monday, Wednesday, and Friday ($285/month)

Monday - Friday ($355/month)

3 year old Class

Monthly Tuition Rates

Mon, Wed, Fri ($265)

Monday - Friday ($335)

4 year old Class

Monthly Tuition Rates

Monday - Friday ($335)

I agree/decline to grant the Diocese of East Carolina permission to use photos submitted in any form as part of any future productions made by or for the Diocese of East Carolina, and further, that such use shall be without payment of fees, royalties, special credit, or other compensation. (St. John’s Preschool is associated with the Diocese of East Carolina per St. John’s Episcopal Church.) *

Agree

Decline