ONLINE APPLICATION - PLEASE COMPLETE ALL INFORMATION Name of Person Completing Form (required) Your Email Address (required) Your Contact Number (required) PROGRAM SELECTION Select the School Year Applying For (Required) ---2015/16 School Year Please Select Program Preference (Required) ---Preschool: Tues,Thurs - Half Day $180/moPreschool: Tues, Thurs - Full Day $300/moPreschool: Mon, Wed, Fri - Half Day $255/moPreschool: Mon, Wed, Fri - Full Day $385/moKindergarten Prep: Mon-Fri - Half Day $400/moKindergarten Prep: Mon-Fri - Full Day $550/mo Will You Be Needing CYFD Assistance? (Required) ---Yes - I Already Applied and It is Pending/Have Been Approved.Yes - But I Have NOT Applied Yet.No STUDENT INFORMATION Child's Name (Required) Mailing Address, City, State, Zip (Required) Home Phone (Required) Birth Date (Required) Gender (Required) Male Female Church (Required) Pastor's Name (Required) Language Spoken At Home (Required) Child Lives With: (Select All That Apply) Mother Father Other Parents Are: Married Divorced Separated Widowed Sibling Names & Ages MOTHER INFORMATION Mother's Name Mother's Address, City, State, Zip Mother's Home Phone Mother's Cell Phone Text Yes No Mother Work Phone Mother's Email Address Mother's Employer Mother's Employer Phone Mother's Personal Statement of Relationship with Jesus Christ FATHER INFORMATION Father's Name Father's Address, City, State, Zip Father's Home Phone Father's Cell Phone Text Yes No Father Work Phone Father's Email Address Father's Employer Father's Employer Phone Father's Personal Statement of Relationship with Jesus Christ SIGNATURES I, the parent of above child, hereby provided Passion Preschool with complete up-to-date, and accurate and factual information. I understand that any false or omitted information could result in denial of admission or immediate withdraw. I understand that signing this statement that I agree to accept the rules and regulations of the school as stated in the Passion Preschool Parent Handbook. Mother's Electronic Signature (First and Last Name) Father's Electronic Signature (First and Last Name) I hereby release Passion Preschool and Passion Church Inc. and any representative of the school/church from any liability or responsibility for injuries, damages or expenses that may occur to the above named student from any school activity. I agree to indemnify and save harmless Passion Preschool and Passion Church and any representative of the school/ church against any such claims for injuries, damages, or expense made by or on the behalf of the above student. I understand that Passion Preschool does not carry liability or accident insurance coverage. Mother's Electronic Signature (First and Last Name) Father's Electronic Signature (First and Last Name) I understand that my child’s likeness may be photographed or videotaped by the school in the course of school activities. I hereby give consent for the school to use my child’s likeness and name in promotional and/or advertising materials, including the use of video and still photos on the school’s website with no financial or other remuneration. Mother's Electronic Signature (First and Last Name) Father's Electronic Signature (First and Last Name) Upon completion of this application, parent(s) will need to provide the $25 application fee, and the child's original birth certificate and current shot record to the admission office to photo copy and place in the child's student file. Additional forms will be completed in the admission office to complete application process. Once application is submitted online, the admission office will contact you to schedule an appointment.