Registration Child's Name* First Last Name Child goes byBirth Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*MaleFemaleParent/Guardian's Names*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Subdivision PhonePhonePhonePrimary Email Secondary Email Physician's NamePhysician's Phone NumberDoes your child have allergies?Does your child receive any special services?Any special comments about your child that you feel would be helpful to the teachers?(Please include any known fears, medical conditions, etc.)Are you a Member of Leesburg Presbyterian Church*YesNoHow did you hear about our preschool?Tuition Costs: For the 2021/2022 school year you have two options when it comes to our enrichment program. 1. You can sign up by semester. We offer 2 semesters...Semester #1 goes from September-January and encompasses our first 4 themes. Semester #2 goes from February-May and covers our last 4 themes. Just fill out the online registration form (choosing am or pm) and once received we will contact you to find out which semester you are interested in. This is the most economical way to sign up because the cost for each month in that semester is $160. 2. Need more flexibility this school year? Then signing up per session will be better for you. Pick the theme(s) you like best, decide if you want an am or pm class, and then fill out the online registration form. Once your registration is submitted you will be contacted to find out what month/theme you are registering for. The cost for this option is $170 per month that you sign up for. Age Class Days Single Month Tuition Full Semester Enrollment 3 by 09/30/2021 Morning, 2-Day Tu, Th 9:30 - 11:30 $170 p/m $160 p/m 4 by 09/30/2021 Morning, 2-Day Tu, Th 9:30 - 11:30 $170 p/m $160 p/m 3 by 09/30/2021 Afternoon, 2-Day Tu, Th 12:30 - 2:30 $170 p/m $160 p/m 4 by 09/30/2021 Afternoon, 2-Day Tu, Th 12:30 - 2:30 $170 p/m $160 p/m Class Selection*Please select which class you are enrolling forMorning EnrichmentAfternoon EnrichmentCommentsThis field is for validation purposes and should be left unchanged.