3 and 4 year application

Child's Name *

First

Last

3 or 4 year old? *

Date of Birth *

Gender *

Street Address *

Town *

State *

Zip Code *

Phone *

Email *

Parent 1 Name *

First

Last

Parent 2 Name

First

Last

Monday *

Monday extras

Early drop-off 8 AM - 9 AM
After care 3 PM - 4 PM

Tuesday *

Tuesday extras

Early drop-off 8 AM - 9 AM
After care 3 PM - 4 PM

Wednesday *

Wednesday extras

Early drop-off 8 AM - 9 AM
After care 3 PM - 4 PM

Thursday *

Thursday extras

Early drop-off 8 AM - 9 AM
After care 3 PM - 4 PM

Friday *

Friday extras

Early drop-off 8 AM - 9 AM
After care 3 PM - 4 PM

Are you a DNPCCNS alumni?

Are you a Dutch Neck Presbyterian Church Member?

Signed (Full name of member of DNPCCNS) *

"I acknowledge that I have read the information enclosed and agree to fulfill my obligations while my child is enrolled in DNPCCNS. I also attest to the fact that all the information given on the registration forms by me is accurate and true."
Note: After submitting, you will be asked to submit the NON_REFUNDABLE registration fee of $100.00 via the Zelle payment platform.