Peace Patch Preschool Enroll Form – Manchester Church of the Brethren

The non-refundable enrollment fee is $15.00.
Child's Name:
First Last
Parent's Name #1:
First Last
Parent's Address #1:
Street Address Address Line 2 City State ZIP Code
Parent's Email #1
Parent's Phone #1:
Parent's Name #2:
First Last
Parent's Address #2:
Street Address Address Line 2 City State ZIP Code
Parent's Email #2
Parent's Phone #2:
Child’s Birth date:
MM slash DD slash YYYY
I/We wish to enroll our child in the following class:
- 3 year-old class - Must be 3 years old by August 1
- 4 year-old class - Must be 4 years old by August 1
Name
This field is for validation purposes and should be left unchanged.