Preschool Pre-Registration 2021-2022

Child's Name

First

Middle

Last

Parents' Name(s)

Street Address

Address 2

City/Town

Province

Postal Code

Email Address

Home Phone

Cell Phone

First Language

Child's Birth Date

type in directly or use date picker

Age as of December 31, 2021

Child must be 3 years old by this date to enroll.

Child is potty trained, or will be by Sept. 1, 2021

Yes

No

Gender

Male

Female

Health Information

Please list all relevant health information (allergies, medications, physical limitations, etc.), including any concerns you may have.

Program

Two days

Tuesday and Thursday $120/month

Three days

Monday, Wednesday, Friday $170/month

Five days

Monday through Friday $265/month

Space is limited and will be on a first-come, first-served basis. Submitting this form is only the first step to securing your spot. You must pay the $40 non-refundable pre-registration fee before your spot is secured.

I will pay the $40 non-refundable pre-registration fee within 48 hours to secure my spot.

Payments may be made by cash or cheque (drop off at church mail slot), or by e-transfer to finances@concordialive.ca. In the message area, please include the child's name and that this payment is for preschool pre-registration. E-transfers are automatically deposited, so they do not require a password.