HOPE Community Preschool
and Family Ministries
9411 Baltimore Road
Frederick, Maryland 21704
301-662-1303
www.hopemtcarmel.org
HOPE at New Market
New Market United Methodist Church
5501 Old New Market Road
New Market, Maryland 21774
301-865-3530
www.newmarketumc.com
2017-2018 Registration Form
Student Information:
______________________________________
__________________________/_____/___
First
Nickname
Middle
Last
Parent/Guardian
Date of Birth
Parent/Guardian
___________________________________
First Name
Last
_________________________________
First Name
Last
_____________________________________
Home Address
_________________________________
Home Address
_____________________________________
City
State
Zip
_________________________________
City
State
Zip
_____________________________________
Home Phone
Cell Phone
_________________________________
Home Phone
Cell Phone
_____________________________________
Email Address
_________________________________
Email Address
_____________________________________
Business Phone
_________________________________
Business Phone
Additional Information:
Brothers and Sisters
DOB
Gender
School Attending
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Are you a member of Mt. Carmel UMC or New Market UMC?
Yes
No
If not, how did you hear about us? _________________________________________________
Please list any previous group experiences and/or early childhood programs attended:
______________________________________________________________________
Does your child have an IFSP (through the Infants and Toddlers Program) or and IEP
(through Child Find)? Both programs are early intervention programs offered through
Frederick County Public Schools for young children with special needs. If so, we will
request a copy of their goals that were established during your meeting to help them
to be successful at HOPE Preschool.
____Yes ____No If yes, please identify their educational disability: ___________________________
Please indicate your 1st and 2nd choices from the locations below 
2 years by 9/1/17
2’s class
Mount Carmel
Tues./Thurs.
9:15-11:45
$170.00/mo.
Tues./Thurs.
12:30-3:00
$170.00/mo.
Mon./Wed./Fri.
9:15-11:45
$205.00/mo.
Tues./Thurs.
9:00-11:30
$170.00/mo.
Mon./Wed./Fri.
12:30-3:00
$205.00/mo.
Mon./Wed./Fri.
9:00-11:30
$205.00/mo.
Monday thru
Friday
12:15-3:15
$315.00/mo.
New Market
Mon./Wed./Fri.
12:30-3:00
$205.00/mo.
(Pull-ups if needed)
2 years by 9/1/17
2’s and 3’s
(Pull-ups if needed)
3 years by 9/1/17
3’s
(Potty-trained)
3 years by 9/1/17
3’s
(Potty-trained)
3 years by 9/1/17
3’s
(Potty-trained)
4 years by 9/1/17
4’s
(Potty-trained)
K-Prep 4 by 9/1/17
AND entering
kindergarten the
following year
3 years by 9/1/17
Kindergarten
Prep
(Potty-trained)
3’s and 4’s
(Potty-trained)
K-Prep 4 by 9/1/17
AND entering
kindergarten the
following year
Kindergarten
Prep
Monday thru
Friday
8:45-11:45
$315.00/mo.
(Potty-trained)
Mount Carmel location: Lunch Bunch will be offered every day (11:30-12:30) and Let’s Play is offered on
Monday, Wednesday and Friday (10:30-11:30 or 12:30-1:30).
New Market location: Lunch Bunch will be offered M/W/F from 11:30-12:30. No Let’s Play.
Extended Day forms are sent home each month to register for these programs.
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Parent/Guardian Signature
___________________________________
Date