Registration Form

Please complete this form & mail registration fee of $50.00 (Made payable to Goshen Christian School) & mail (see below).

The registration fee can be mailed to:

Goshen Christian Preschool
2430 State Route 17A
Goshen, NY 10924

Tuition Rates:

3 Day Program- $1800 yearly; $180.00 monthly
4 Day Program- $2400 yearly; $240.00 monthly

Click here to download this form in PDF format

*Goshen Christian Preschool makes no discrimination in admissions or determination of enrollment on the basis of race, creed, sex, color, or national origin.

Child's Name *

Name of parents or guardian *

Email *

Address *

City *

State *

Zipcode *

Child's date of birth *

Month

Day

Year

Please choose *

Natural Child

Adopted Child

Parents *

Married

Separated

Divorced

Father's place of employment

Father's Cell Phone

Father's Work Phone

Mother's place of employment

Mother's cell phone

Home phone

Family physician's name *

Family physician's phone *

Please list any health problems & medications child is presently taking

Name and phone numbers of two additional persons to in the event of an emergency (other than parent): *

Is mother a member of a church? *

Yes

Name and location

Is father a member of a church? *

Yes

Name & location

Does your child attend Sunday School? *

Yes

If so, where?

Names and ages of brothers and sisters

Does your child receive extensive care by anyone other than parents? *

Yes

If so, by whom?

How does your child relate to other children? *

How does your child relate to adults? *

Previous group experiences of child *

Are there any particular behavioral concerns you wish us to be aware of? *

What helps to reassure your child when upset? *

How would you describe your child’s personality? *

Favorite pastimes and interests *

Does your child enjoy being read to? *

Does your child enjoy singing? *

What hand is usually used? *

Left

Right

Please list experience with use of creative material such as clay, crayons, markers, scissors, tape, glue, paint, etc. *

Does your child participate in cleaning up his belongings? *

Yes

Dress self? *

Yes

Is child completely toilet trained? *

Yes

child must be self sufficient in the bathroom

Are there any speech difficulties that we should be aware of?

Allergies?

Is there anything that you are specifically hoping for your child to accomplish in preschool this year?

Please add any additional information or comments that might further the understanding of your child

Please choose a program

Please select a program

3 year old (Mon.,Wed., Fri.) (3 day) 9-12:00 (Morning Session)

4 year old (Mon.,Wed., Fri.) (3 day) 9-12:00 (Morning Session)

4 year old (Mon., Tues.,Wed., Fri.) (4 day) 9-12:00 (Morning Session)