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Registration packet
Spumc Weekday school

Dear Parents,
Please take the time to fill out the 2013-2014 registration packet, submit
it with your $65.00 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 beginning
February 11, 2013 for currently enrolled students or siblings. Open
registration for the public begins March 4.
SPUMC Weekday School will follows the 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

SPUMC Weekday School

2013-2014 Payment Guidelines
Class

Registration Fee

Activity Fee

(non-refundable)

(non-refundable)

Monthly Tuition

PMO

$65/ school year

$0

$115/ month

2s

$65/ school year

$20/ school year

$125/ month

3s
(3 day)

$65/ school year

$55/ school year

$160/ month

4s
(3 day)

$65/ school year

$60/ school year

$160/ month

4s
(5 day)

$65/ school year

$60/ school year

$210/ 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).

I am registering my child for the:

PLEASE CIRCLE
PMO Program (Wed)
2 year-old class (Mon & Thurs)
3 year-old class (Mon, Wed, Fri)
4 year-old class (Mon, Wed, Fri)
4 year-old class (5 days)
Childs Name ____________________________________________________________
(First)
(Middle)
(Last)
(Nickname)
Childs Birth date _______________________________ Childs Age ____________________
Fathers Name ________________________________________________________________
Address _____________________________________________________________________
Mothers Name________________________________________________________________
Address (if different from fathers) _______________________________________________________
Preferred E-Mail Address________________________________________________________
Home Phone _____________ Cell # Father______________ Cell # Mother_____________
Fathers Employer__________________________________________ Phone #____________
Mothers Employer__________________________________________ Phone #____________
(work numbers will be used only in an emergency)

Religious Affiliation/Beliefs_______________________________________________________
Allergies/Health Concerns_______________________________________________________
An Individualized Care Plan-ICP (see Health Care Form) is required before beginning school for children
with health care needs, including but not limited to FOOD ALLERGIES & FOOD INTOLERENCES.
Siblings (names and ages) _______________________________________________________

Office Use Only

Registration Fee Paid: __________________(Amt)
Activity Fee Paid: ______________________(Amt)
T-shirt Paid: __________________________(Amt)

Add t-shirt pai

Date: ___________________
Date: ___________________
Date: ___________________

Health Care Form

(Part A Must be completed and signed by the examining physician)
PART A
Name of child ______________________________________________
first

middle

last

Birthdate__________________________________________________
Date of most recent check-up _________________________________
Date of most recent tuberculin skin test________________ Date of Test ___________
1. Does this child enjoy good health free from any chronic conditions? _________
If no, explain______________________________________________________
2. Does this child demonstrate normal motor and mental development? _______
If no, explain ______________________________________________________
3. Should this child have any physical restrictions? __________________________
If yes, explain______________________________________________________
4. Should this child be on any dietary restrictions? __________________________
If yes, explain______________________________________________________
SEE INDIVIDUAL CARE PLAN ATTACHED
VACCINE
DTP/DT
Polio
HiB
Hepatitis B
MMR
Chicken Pox
Prevnar
Other

#1

#2

_________________________________________
Physicians Signature

#3

#4

#5

________________________
Date

(Part B must be completed and signed by the parent)

Part B
1. Does your child have any medical conditions SPUMC Weekday School needs to be
aware of? _______
If yes, explain. ______________________________________________________
2. Does your child have any know allergies or intolerances? _______
If yes, explain. ______________________________________________________
3. Is your child on any special dietary restrictions? ________
If yes, explain. ______________________________________________________
_________________________________________
_________________________
Parents Signature
If your child has not been immunized, note the reason ____personal ___religious _____other

SPUMC Weekday School

INDIVIDULIZED CARE PLAN
Please have your childs physician provide an Individualized Care Plan if your child has special
heath care needs. This plan must be signed and dated by the physician.
This includes, but is not limited to:
Use of medication while at school such as:
Asthma medication
EpiPen
Food allergies or intolerances such as:
Nuts
Peanut butter
Milk
Wheat
Physical or emotional needs such as:
Delayed speech
Physical handicap
This ICP helps protect your child while attending SPUMC Weekday School from coming in
contact with foods that he/she may be allergic to. It also helps the staff at SPUMC Weekday
School provide the best possible care for your child should they have special needs.
I give SPUMC Weekday School permission to post information about my childs food allergy in
the classroom and Weekday School office.
__________________________
Childs Name

_____________________________
Parents Signature

____________
Date

SPUMC Weekday School

Parents, please indicate if you would
like to be included with the following activities...
Initial
E-mail, sent to Weekday School parents for communication

_____

Interested in being a room parent

_____

Interested in organizing fund raisers

_____

Interested in being a mystery reader, sharing my

profession, hobby or interests with my childs class
Hobby/ Interest/ Profession _____________________

_____

Interested in sharing my knowledge of music or

Spanish with the children on a regular basis

_____
_____

Permission to use child(ren)s picture in materials

for the Weekday School (website, posters, etc)

_____

This is to acknowledge that I have received a copy of

South Point United Methodist Church Weekday Schools
Handbook or have reviewed the Handbook on-line.
I have read and agree to uphold all policies and procedures
set forth in the Handbook. I am also aware that revision of
such policies and procedures can take place at any time
and I will be made aware of any changes in writing.

_____

Childs Name
Class
Parents Name
Signature
Date

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

Emergency Contact Information

Childs Name __________________________________________________
Phone Number ________________________ Birth Date _______________
Address ______________________________________________________
_____________________________________________________________
City
State
Zip Code
Mothers (or Legal Guardian) Name ________________________________
Daytime Phone Number __________________________________________
Other Contact Numbers __________________________________________
Fathers Name __________________________________________________
Daytime Phone Number __________________________________________
Other Contact Numbers ___________________________________________
In case of emergency, please list two people who can be contacted if you cannot be reached.
Name and Relationship ___________________________________________________
Phone Number(s) ________________________________________________________
Name and Relationship ___________________________________________________
Phone Number(s) ________________________________________________________
Doctors Name___________________________ Phone #_________________________
Dentists Name ___________________________Phone #_________________________
Hospital Preference ______________________________________________________
Please list any known allergies for your child __________________________________
I agree that any SPUMC Staff Member 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

Name of person(s) that are allowed to pick-up Child on regular basis ______________________
______________________________________________________________________________

SPUMC Weekday school t-shirts

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.
Our design is new this year so everyone will need to purchase a shirt. Thank you in
advance.
STUDENT NAME: ________________________________________
CLASS: ________________________________________________
SHORT SLEEVE SHIRT YOUTH:
2T

4T

5/6

Circle size ordered

__________ x
Number of shirts

$12/ SHIRT