Living Savior Preschool Registration and Payment Form
Please fill out this form and click submit.
Child's Full Name
*
Child's Date of Birth
*
Child Lives With:
*
Please select one option.
Both Parents
Father
Mother
Father's Name
*
Mother's Name
*
Father's Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Mother's Address
*
Please select all that apply.
Same as Above
Different [Fill Below]
Mother's Address (if different)
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Father's Phone
*
Father's Email
*
This address will receive a confirmation email
Mother's Phone
*
Mother's Email
*
This address will receive a confirmation email
Class Sessions are Full Days or Half Days
*
Please select all that apply.
3 days/week [$400/mo - $412/mo Credit Card]
4 days/week [$530/mo - $545.90/mo Credit Card]
5 days/week [$650/mo - $669.50/mo Credit Card]
3 half days/week (8:30-11:30AM) [$200 mo - $206/mo Credit Card]
4 half days/week (8:30-11:30AM) [$265/mo - $272.95/mo Credit Card]
5 half days/week (8:30-11:30AM) [$325/mo - $334.75/mo Credit Card]
3 half days/week (12:00-3:00PM) [$200 mo - $206/mo Credit Card]
4 half days/week (12:00-3:00PM) [$265/mo - $272.95/mo Credit Card]
5 half days/week (12:00-3:00PM) [$325/mo - $334.75/mo Credit Card]
Desired Days of Week [Class Sessions are limited to 15 children. Filled on first-come, first-served basis.]
*
Please select all that apply.
Monday
Tuesday
Wednesday
Thursday
Friday
Registration Fee $50 [Check/Cash in Person or by Mail [Non-refundable]
Cash/Check ($0)
Credit Card [$51.50]
Cash/Check ($0)
Credit Card [$51.50]
Amount
Preschool Payment [Check/Cash in Person or by Mail] [See Schedule Above]
Cash/Check ($0)
Credit Card
Cash/Check ($0)
Credit Card
Amount
Questions? Contact April Best 406.240.0625 or visit livingsaviormissoula.org - Preschool Link
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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