Collierville First pentecostal church - Collierville First Pentecostal Mother\'s Day Out

Note: Processing Fee must be covered with online payment.
Please use the drop down fund option to select: “Collierville First Pentecostal Mother’s Day Out Tuition" to make payment. Any notes can be added in second screen before submitting payment if payment is for other Mother’s Day Out related expenses.

Church Members Monthly Tuition Fees:

Registration/Curriculum Fee: $100.00 per student (non-refundable)
Monthly Tuition (Members):
Students: $200.00

Non-members Criteria:
Family must be Apostolic in faith and a member in good standing of an Apostolic church.
Student requires a completed reference form from their pastor.

Non-members Fees:
Registration/Curriculum Fee: $125.00 per student
Monthly Tuition: $225.00 per student
For more information, please contact:

Sister Cindy Hunt @ 901-485-0569
Sister Regina Blanton @ 901-326-6805
Email: Regina.blanton@colliervillefpc

Pay Tuition

Student's First Name

Student's Last Name

Student's Birthdate

Gender

Prerequisite for admission to CFPF Mother's Day Out

Birth Certificate

Immunization Record

Email Records to

Mother's First Name

Mother's Last Name

Mother's Email

Mother's Phone Number

Father's First Name

Father's Last Name

Father's Phone Number

Father's Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Emergency contacts (other than parents) List names & phone numbers

Authorized people to pickup child from the school. Please list names and phone numbers.

In case of emergency, I give permission to the school authorities, or its representatives to obtain medical treatment of my child in my absence.

I agree

I do not agree

Child's Physician

Physician's Phone Number

List any physical difficulties

Liability Waiver : I hereby release and agree to hold CFPC Mother’s Day Out/Collierville First Pentecostal Church (CFPC) harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, Claims, demands, damages, cost, expenses and compensation for damage or loss to myself, my heirs and/or property that may be caused by any act, or failure to act on the school/church, or that may otherwise arise in anyway in connection with any services CFPC Mother’s Day Out/CFPC. I understand that this release discharges CFPC Mother’s Day Out/CFPC from any liability or claims that I, my heirs, or any personal representatives may have against the school/church with respect to any bodily injury, illness, death, death, medical treatment, or property damage that may arise from, or in connection to, any services received from CFPC Mother’s Day Out/CFPC. This liability waiver and release extends to the school/church together with all owners, partners, and employees.

I agree

Signature

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