From: Debbie Blades [debra@whumc.com]
Sent: Friday, November 16, 2007 10:51 AM
To: pam@whumc.com
Subject: NEW APPLICATION.05.doc

Attachments: _AVG certification_.txt

Creative School

Application for Admission

2008-2009

Child’s Name______________________________________Boy____Girl____

Address______________________________________Phone_____________

City____________________________ Zip Code_______________                        

Date of Birth ___________Child’s Age (on September 1^{st) Years}____Months___

E-Mail Address _________________________________________

____Registration Fee – 175.00 (Non-Refundable)              Classes 9:00-Noon

____Kindergarten Registration – 200.00 (Non-Refundable)            9:00–2:00

____ 160/MO. Tu/Th 2’s                          Extended Care Noon – 2:00

____ 235/MO.  MWF 2’s                            Monday – 35/MO.                   _____

____ 160/MO. Tu/Th 3’s                           Tuesday - 35/MO.                  _____

____ 235/MO.  MWF 3’s                            Wednesday-35/MO   .           _____

____ 250/MO. M-Th 4’s                            Thursday – 35/MO.                _____

____ 310/MO. M-F 4’s                               Friday – 35/MO.                    _____

____425/MO.   Kindergarten

SEPTEMBER TUITION IS DUE MAY 1ST

**********************************************************

______________________________________________________________

Father’s Name                          Address-(If Different from Child)            Phone #

Business Phone______________________      Cell Phone___________________

______________________________________________________________

Mother’s Name                        Address – (If Different)                              Phone #

Business Phone______________________       Cell Phone__________________  

Mother’s Church Membership_________________

Father’s Church Membership _________________

                                                 Parent Signature__________________________

IN AN EMERGENCY, IF THE PARENTS CANNOT BE LOCATED, THESE INDIVIDUALS MAY BE CALLED, AND IF NECESSARY THE CHILD MAY BE RELEASED TO THE FOLLOWING:

RELATIVE OR FRIEND                  ADDRESS- ZIP CODE                                          PHONE

_________________________________________________________

RELATIVE OR FRIEND                   ADDRESS-ZIP CODE                                          PHONE

_________________________________________________________

RELATIVE OR FRIEND                   ADDRESS-ZIP CODE                                          PHONE

RELEASE FORM

IF MY CHILD BECOMES ILL OR INJURED, I AUTHORIZE WHUMC CREATIVE SCHOOL AND ITS AGENTS TO OBTAIN EMERGENCY MEDICAL CARE AT PRESBYTERIAN HOSPITAL OF DALLAS OR THE NEAREST MEDICAL FACILITY, AND I HEREBY RELEASE SAID SCHOOL AND ITS AGENTS FROM LIABILITY FOR ACTION TAKEN PURSUANT OF THIS RELEASE.

Signature of Parent or Guardian                                     Date

*******************************************************************

ENROLLMENT IS NOT COMPLETE UNTIL THESE ITEMS ARE SUBMITTED TO THE CREATIVE SCHOOL OFFICE:

CONTRACT ___

REGISTRATION FEE ___

ENROLLMENT FORM ___

MEDICAL FORM SIGNED BY PHYSICIAN ___ * DUE AUGUST 31^{st *}  

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