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Admission Application
*Please note that we cannot officially hold a place for your child until we have received the $25 supply fee, as well as the last month of tuition. Please make checks payable to Union Preschool and send them to 1461 N. 1525 E. in Logan (84341). Remember, financial aid is available for families that qualify; please let us know if you are interested.
Admission Application
Full Name of Child
(required)
Preferred Name of Child
(required)
Month of Birth
January
February
March
April
May
June
July
August
September
October
November
December
(required)
Day of Birth
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Email
(valid email required)
Mother's Name
Mother's Phone
Employer & Occupation
Father's Name
Father's Phone
Employer & Occupation
Your Childs Interests, Personality, etc...
Native language of child
Preferred schedule for child (check one box)
2 days/week (Tue/Thur): $99/month
3 days/week (Mon/Wed/Fri): $140/month
5 days/week (Mon - Fri): $220/month
Preferred class time (morning 9 - 12 / afternoon 1-4)
Morning
Afternoon (not available fall 2009)
Are you interested in being on the Union Preschool Committee?
Yes, please add my name to the list
No thanks
How did you hear about Union Preschool?
Health Information
Any allergies to medication, foods, etc.?
(required)
Does your child have any of the following?
Asthma
Diabetes
Seizures
Heart Problems
Hearing Impairment
Visual Impairment
Developmental Delays
Physical Impairment
Behavioral/Emotional Problems
Other
Other
Any health info / instructions we need to know of?
Any regular medications?
Your child's doctor?
Your child's doctor's phone number
Emergency Contact Information
Name
(required)
Telephone Number
(required)
Address
Relationship to Child
Out of State Emergency Contact
Telephone Number
Address
Others authorized to pick up your child
Verify the information above
I have verified that the above information is correct and true.
I have verified that the above information is correct and true.
I have verified that the above information is correct and true.
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Home Language Reinforcement / Reforzamiento del lenguaje en casa
Admission Application
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Supply Fee Payment ($25.00)