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Dear Parents,
Please take the time to fill out the 2012-2013 registration packet,
submit it with your $55.00 registration fee and applicable activity
fee (fees differ for each class) to hold your childs place in the
Weekday School. Open spaces are filled on a first come, first
served basis. In order to assure your childs place in the Weekday
School, it is recommended that you submit the registration forms
and fees as soon as possible.
SPUMC Weekday School will follow the new NC Public School
entry date of August 31st. Your childs age must correlate with the
appropriate class.
We look forward to a wonderful year!
The Weekday School Board of Directors
Weekday School Staff
South Point United Methodist Church
Registration Fee
Activity Fee
(non-refundable)
(non-refundable)
Monthly Tuition
PMO
$0
$60/ month
2s
$105/ month
3s
(2 day)
$115/ month
3s
(3 day)
$135/ month
4s
(3 day)
$135/ month
4s
(5 day)
$175/ month
To confirm your childs place in the Weekday School, both the non-refundable
Registration Fee and the non-refundable Activity Fee must be paid at the time of
registration. The Activity Fee will include everything except Scholastic book orders,
Pennies from Heaven, t-shirt sales, pictures and our 2 fundraisers (all optional). For field
trips including parents, these fees cover the cost of one parent. They also include a
Handwriting Without Tears Workbook (3s and 4s) for your child and a monthly
subscription to Scholastic magazine (4s).
___________________
___________________
___________________
___________________
___________________
___________________
PHYSICAL EXAMINATION
(Must be completed and signed by the examining physician)
Name of child ______________________________________________
Weight ____________
Height ____________
Heart ____________
Chest ____________
Throat ____________
Neck ___________
EXT ____________
Skin ____________
Head ____________
#1
#2
#3
xxxxxxxxxx
#4
#5
xxxxxxxxxx
xxxxxxxxxx
xxxxxxxxx
xxxxxxxxx
xxxxxxxxx
xxxxxxxxx
_________________________________________
________________________
Physicians Signature
Date of Examination
_________________________________________
________________________
Office Address
Telephone Number
5
Childs Name _______________________________ Age _____ Birth date _________
Medical History
1. Is your child allergic to anything? Yes _____ No _____
If so, what? ________________________________________________________
2. Has your child had a serious illness, surgery or hospital stay? Yes _____ No _____
If so, please describe: ________________________________________________
3. Does your child have any physical handicaps? Yes _____ No _____
If so, please describe: ________________________________________________
4. Is your child currently under the care of a Doctor? Yes _____ No _____
If so, for what reason? _______________________________________________
Medical Information
Hospital Preference _______________________________________________________
I agree that the director may authorize the physician of his/ her choice to provide
emergency care in the event that neither the family physician nor I can be contacted
immediately. This is done with the understanding that every attempt will have been
made to contact the parents, the childs physician and other persons listed for emergency
contact.
______________________
__________________________________________
Date
Signature of parent or guardian
_____
_____
_____
_____
_____
_____
_____
Childs Name
Class
Parents Name
Signature
Date
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
_____
In case of emergency, please list two people who can be contacted if you cannot be reached.
We ask that each child in the 3 and 4 year-old classes purchase a school t-shirt.
These will be worn on field trips. Everyone is welcome to purchase a shirt. We
have adult sizes too! The t-shirt order form is below and should be returned with
registration fees. Returning students that already have t-shirts do not need to
purchase new ones unless they would like to. Thank you in advance.
STUDENT NAME: ________________________________________
CLASS: ________________________________________________
SHORT SLEEVE SHIRT YOUTH:
XS
__________ x
$10/ SHIRT
Number of shirts
XL
XXL
__________ x
Number of shirts
TOTAL:
____________
$12/ SHIRT
$__________