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10792 N Co Rd 210 E
Seymour, IN 47274
PHONE: 522-7484
Director: Carolyn Jones 812-521-0281
We are now accepting enrollment for the school year scheduled to begin the fall of 2015.
Enrollment is open to all children in the community. Enrollment is on a first-serve basis. Class
sizes are limited.
To enter Preschool in August, 2015, your child must be; age 4 years by August 1, 2015 for
Sunbeam Class; age 3 by August 1, 2015 for the Rainbow Class; or age 2 by August 1, 2015 for
the Raindrop Class.
Offered will be: stories, socialization skills, colors, shapes, painting, coloring, writing
name, following directions, cutting, role playing, alphabet, letter sounds, numbers, Bible Stories,
puppets, music, rhythm, coordination skills, exercise, field trips, snacks, outdoor play, centers,
computers, and much more.
The yearly Enrollment Fee is $45.00 for one child and $65.00 for two children per family.
Enrollment fees are paid when sending Enrollment Form. Tuition for each class is as follows:
Tuition is based on a yearly rate. Parents may choose to either pay the entire yearly rate at
one time or pay monthly.
Sunbeams 4/5 ($750 per year or $75.00 a month from August-May)
Rainbows 3/4 ($500 per year or $50.00 a month from August-May)
Raindrops 2/3 ($200 per year or $25.00 a month from Sept-April)
Sunbeams meet on Monday, Wednesday, and Friday from 9:00-11:30 August-May.
Rainbows meet Monday and Wednesday from 9:00-11:30 August-May.
Raindrops meet on Fridays from 9:00-11:30 September-April.



Childs Name __________________,__________,____________________




Home Phone______________________ Birth Date___________________________
(month, day, year)
Email Address___________________________________________________
Name I wish my child to be called at school_______________________________
Fathers Name__________________________Employer_______________________
Work Phone___________________________ Cell Phone_______________________
Mothers Name_________________________Employer________________________
Work Phone___________________________ Cell Phone_______________________
Emergency Name and Number (someone to call if we cant reach parents)
Medical, Diet, Allergies, or Surgical Restrictions________________________________________
Right Handed______Left Handed_______Any Fears or Habits_____________________________
Class your child will be in Pre-school
4/5 Class________

3/4 Class_______

2/3 Class________

What school will your child attend next year (4/5 Class only)?_____________________________
Siblings and ages:________________________________________________________________
Family Physician_______________________ Phone #_________________________
Family Dentist________________________ Phone #_________________________
Hospital Preference______________________________


In case of emergency, and we are unable to reach parents, do we have your permission to seek
emergency medical treatment? Yes_____ No_____
Do you give Borchers Preschool permission to put pictures of your child on their website? Yes________
Preschool reminders and cancellations will be posted on our Borchers Preschool Facebook page and on the
St Paul Lutheran Church, Borchers website.
If you want to check Facebook/website for reminders please check here___________.
If you dont have Facebook and would like a text message please check here__________.
Phone number to text_________________________

Parents Signature________________________________Date______________
Parents Signature________________________________Date______________
I wish to pay monthly______ or yearly______