The Flock Preschool at Epworth UMC

1030 Burrage Road, NE, Concord, NC  28025

Pre-registration Form for 2010-2011

*Please complete the following form and return it and the $50.00 pre-registration fee to Teresa Gray, Director of The Flock Preschool, at Epworth UMC, 1030 Burrage Road, NE, Concord, NC  28025.

Child’s Name:  ___________________________________________  Birthday:__________________

                               First Name                                  Last Name

Address:___________________________________________________________________________

               Street                                                                      City                                    State                    Zip

Phone Numbers:_____________________________________________________________________

                                Home                                                       Work                                               Cell

Parents’/Guardians’ Name(s):__________________________________________________________

Relationship to Child:_________________________________________________________________

Email Address(es):___________________________________________________________________

Below is a list of the programs that will be offered at The Flock Preschool for the 2010-2011 school year.  Please put an “X” in the box next to the program in which you would like to enroll your child.

Note:  Beginning in the 2009/2010 school year, students attending Kindergarten in NC must be 5 years of age on or before August 31st.  At the Flock, we enroll children based on this same “cut-off” date.  If you have questions or concerns about classroom placement, please set up an appointment with Mrs. Teresa to be sure that the best decision is made for your child.