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Child’s First Name____________________ Last Name_______________________

Parent’s First Name___________________ Last Name______________________

Address_____________________________________________________________

Postal Code________________________ Home Phone Number________________

Email Address______________________ Child’s Birth Date__________________

Check desired class indicating first and second choices.

All Classes are subject to enrollment.

Monday and Wednesday A.M. (3 & 4 year olds) 9:15-11:30 am ____

Tuesday and Thursday A.M. (3 & 4 year olds) 9:15-11:30 am ____

Tuesday, Wednesday, Thursday P.M. (4 year olds only) 1:00-3:15 pm ____

NOTE: Child must be turning 3 during first session in A.M. Classes.

Child must be turning 4 during first session in P.M. Classes.

Check if your child has any existing medical concerns.

Please notify staff at our Open House (i.e. Asthma, allergies, etc.) _____

Please turn in pre registration form as soon as possible. This registration form must be completed and a $50.00 (NON-REFUNDABLE) DEPOSIT must be attached to ensure your child’s enrollment for September 2009. Once you have submitted your registration form and deposit, you will receive a package detailing our program, philosophy, and payment plan.

CLASS FEES ARE $9.00 PER CLASS FOR THE NURSERY SCHOOL PROGRAMS.

Your $50.00 deposit will be applied towards your 1st term payment

PAYMENT AMOUNT_____________VIA: CHEQUE________

SIGNATURE:_________________________CASH ________

CONTACT: Patricia Postello 633-5410 or Tami Philips 633-5615

Questions? Email us at info@jnns.ca or call (204) 953-1193