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Please return postmarked by August 31 for the Fall session and by
February 1 for the Spring session.
Write check and mail to:
St. Matthew Lutheran School PPH
818 W. Wisconsin Ave.
Oconomowoc, WI 53066

Parent's Name:_______________________________________________________

Parent's Address:____________________________________________________

_____________________________________________________________________

Home Phone Number:___________________________________________________

Who will be bringing the child(ren) to Preschool Power Hour?

_____________________________________________________________________

Address and telephone if different than parents:______________________

_____________________________________________________________________

Names and ages of all children 0-4 yrs who will be attending PPH
(Please include infant siblings)

Name:_____________________________ Name:_____________________________

Name:_____________________________ Name:_____________________________

Name:_____________________________ Name:_____________________________

Cost is $10.00 per child per session (18 mos.-4yrs. only). Infant
siblings are welcome to attend at no cost.

____ number of children x $10 = $________

How did you hear about our program?

Newspaper_____ Friend_____ Brochure_____ Other (specify)_____________