TLC Application Page - Pulaski Wesleyan Church

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Entrance Requirements

Application Form

Student Information

* Indicates required field

Student's Name *

First

Last

Date of Birth *

Sex *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Any Allergies? *

Yes No

If so, what? *

Anything Else we need to know about your child? *

Parent's Information

Mother's Name *

First

Last

Address (If different from student) *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Occupation *

Place of Work *

Work Phone Number *

Email *

Father's Name *

First

Last

Address (If different from student) *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Occupation *

Place of Work *

Work Phone Number *

Email *

Siblings:

Name *

First

Last

Sex *

Age *

Name *

First

Last

Sex *

Age *

Name *

First

Last

Sex *

Age *

Does your family regularly attend church? *

Yes No

If so, where? *

Emergency Contact (other than parent) *

First

Last

Phone Number *

Babysitter's Name (Daytime sitter) *

First

Last

Phone Number *

Classes Offered

3 Year Olds - *$75.00 per month *

2 day 3 year olds meeting Mon./Wed. 9:30-11:30am 2 day 3 year olds meeting Tues./Thurs. 9:30-11:30am

4 Years Olds *

2 day 4 year olds meeting Tues./Thurs. 9:30-12:00pm *$80.00 Per Month 4 day 4 year olds meeting Mon. - Thurs. 9:30-12:00pm *$135.00 Per Month

*Tuition costs are subject to change

I understand that I will pay the monthly tuition cost for the class I have chosen above. There is a $50.00 non-refundable registration fee if paid by August 9th. Starting August 10th the non-refundable registration fee is $60.00. The registration fee includes the cost of a TLC T-shirt (to be given out the first week of school.) I will give a 30 day notice if I have to withdraw my child from TLC at any time and I am responsible for tuition during that period of time. *

I Understand

We cannot guarantee a place for your child until the
registration form and registration fee have been received.

Signature *

T-shirt size (choose one) *

2/4 6/8 10/12

I have enrolled my child in the Universal Pre-K program *

Yes No

Submit

WE'RE ALL ABOUT JESUS

Pulaski Wesleyan Church is a Jesus-loving church in Pulaski, New York.
We are committed to loving God and living his Word. We believe in connecting with people, growing together, and reaching our into our community to serve, and protect.

CONTACT US
4591 US Route 11
Pulaski, NY

office@pulaskiwesleyan.org
1 (315)-298-5526

Instagram Link

Google+ Link

© Copyright 2018, Pulaski Wesleyan Church All Rights Reserved.

I'm New
Ministries
TLC
- TLC Application Page
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