PMO 2026 - 2027 School Year Registration

PMO Enrollment Form

FPC Atlanta 2026-2027 School Year
Please complete this registration form for each child you are enrolling for the 2026 - 2027 school year.
Student Information
Student's Full Legal Name*

First NameMiddle NameLast NameSuffix
Student Preferred Name (If different than first name)
Student Date of Birth*

MonthDayYear
Students must at least 8 weeks old prior to starting PMO & no older than 23 months on 9/1/2026
Student Gender*
Student Primary Address*

Street Address

Street Address Line 2

CityState

Zip Code (Five digits only please)
Student's Class for Upcoming School Year*
Tuition Selection:

Families may choose to enroll their children for 2 days/week, 3 days/week or 5 days/week.

Tuition payments are not due at this time. Invoices will be sent when registration has been confirmed. Tuition payments are due by August 3, 2026. Payment plans are available upon request. Tuition is nonrefundable.

Tuition will be prorated for students enrolling after the school year has started.

A 60-day written notice must be given to the Director or Assistant Director when a student withdrawals from our program. You are obligated for tuition for those 60 days.
2 days/week ($3500/year)3 days/week ($4950/year)5 days/week ($7750/year)
Requested Start Date (skip if unknown)

MonthDayYear
Date

Are you a member of First Presbyterian Church of Atlanta? (Y/N)
Please share sibling information below if applicable. Please add first name, school & age. Use the black + button to add more siblings as needed.
Parent/Guardians, Emergency Contacts & Authorized Pick-up Information
Parent/Guardian # 1 Name*

First NameLast Name
Relationship to Student (P/G #1)*
Cell Phone Number (P/G #1)*
Please enter a valid phone number.Format: (000) 000-0000.
Work/Other Phone Number (P/G #1)
Please enter a valid phone number.Format: (000) 000-0000.
Email (P/G #1)*
example@example.com
Parent/Custodial Guardian #2 Name

First NameMiddle NameLast Name
Relationship to Student (P/G #2)
Cell Phone Number (P/G #2)
Please enter a valid phone number.Format: (000) 000-0000.
Work/Other Phone Number (P/G #2)
Please enter a valid phone number.Format: (000) 000-0000.
Email (P/G #2)
example@example.com
Emergency Contact # 1 (Contact in case parents can't be reached) *

First NameMiddle NameLast Name
EC Relationship to Student*
EC Cell Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Emergency Contact # 2 (Secondary contact in case parents can't be reached)

First NameMiddle NameLast Name
EC Relationship to Student
EC Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
All Individuals Authorized to Pick Up Your Child. Use the black + button to add more people as needed.*

PMO Student Health Information
Current Medical Conditions & Major Medical History - Share current medical conditions, past surgeries, hospitalizations and emergency room visits. Use the black + button to add more items as needed. (Type "N/A" if none)*
Non-Food Allergies (Type "N/A if none)*
Food Allergies and/or Dietary Restrictions (Type "N/A" if none)*
Special Needs, Disabilities or Additional Health Information We Should Be Aware of:
Is the student covered by health insurance?*
Front Side of Health Insurance Card (Please upload photo)*

Cancelof
Back Side of Health Insurance Card (Please upload photo)*

Cancelof
Immunization Form/Record (Please upload photo or pdf doc)*

Cancelof
Emergency Medical Authorization
Student Name*

First NameLast Name
Emergency Treatment Provider of Choice*
Parent/Legal Guardian Name*

First NameLast Name
Medical Waiver Agreement:

In the event of an illness or injury to my child while participating in the Parents’ Morning Out program at First Presbyterian Church of Atlanta, I authorize the staff of First Presbyterian Church of Atlanta to secure appropriate medical treatment, including contacting emergency medical services and arranging transportation to a medical facility if deemed necessary.

By signing this form, I understand that reasonable efforts will be made to contact me immediately in the event of an emergency. I accept full responsibility for any medical expenses incurred. I release and hold harmless First Presbyterian Church of Atlanta, its staff, and volunteers from liability related to medical treatment provided in good faith.
Parent/Legal Guardian Signature*

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Date*

MonthDayYear
Date

Participation Acknowledgment & Photo Release
Licensing Exemption:

In accordance with Bright From The Start – GA Department of Early Care and Learning, I understand that First Presbyterian Church’s Parents’ Morning Out program is exempt from state licensure as follows:

290-2-2-.05 (f) 5 Parent's Morning Out, Parent's Night Out, or similar programs which operate for no more than one session of up to four (4) consecutive hours per day and which limit attendance to no more than eight (8) hours a week per child.
By signing below, I acknowledge PMO's licensing exemption.*

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Photography Waiver:

First Presbyterian Church of Atlanta may use my child’s photos and/or videos in promotional materials regarding First Presbyterian Church's Parents Morning Out program.
Yes, I grant media release permissionNo, I am declining media release

PMO Registration Fee

This is a one-time non-refundable annual registration fee. This registration fee is not a deposit and will not be applied to tuition.
I agree
Total Cost
Payment Amount*

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USDPMO Registration Fee - 501784
Payment Methods

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Choose from one of the PayPal options to make your payment.

Contact Info

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PMO Enrollment Form

Student Information

Parent/Guardians, Emergency Contacts & Authorized Pick-up Information

PMO Student Health Information

Emergency Medical Authorization

Participation Acknowledgment & Photo Release

PMO Registration Fee