SCHOOL AGE CLASS

Child's Name *

First Name

Last Name

Gender *

Male

Female

Date Of Birth *

MM

DD

YYYY

Home Phone *

(###)

###

####

First Parent's Name *

First Name

Last Name

First Parent's Cell Phone *

(###)

###

####

Second Parent's Name

First Name

Last Name

Second Parent's Cell Phone *

(###)

###

####

Days in the Program *

You can choose to pay by the day or by the month. Choose your option below. It's $16 a day or $300 a month.

Pay by the Month (M-F)

Pay by the Day (select days)

Monday

Tuesday

Wednesday

Thursday

Friday

Do you have a child currently placed in our program?

Yes

No

Are you an active member of Navarre UMC since Dec. 1st, 2023?

Yes

No

Have you had a child previously attend NUMCP?

Yes

No

Are you registering more than one child for NUMCP this year?

Yes

No

Does your child require an epipen or inhaler?

Yes

No