Tel: (610) 944-8388 • 117 East Arch Street • Fleetwood, PA 19522

Registration

St.-Paul's-Lutheran-Preschool-LogoDownload Registration Packet 2015

117 E. Arch Street, Fleetwood, PA 19522

610.944.0922

2014-2015 Registration  Packet

Student’s Name                                                           M or F   Birth date                                        

Address                                                                                                                                              

Class Choice

________Preschool Program (Tuesday – Thursday)                         $104.00/monthly

________Kindergarten Readiness (Monday – Thursday)         $137.00/monthly

Mother’s Name                                                            Father’s Name                                                

Address                                                                       Address                                                         

                                                                                                                                                            

Home Phone                                                                 Home Phone                                                    

Work Phone                                                                 Work Phone                                                    

Cell Phone                                                                    Cell Phone                                                       

 

I give               /do not give                  permission to St. Paul’s Lutheran Preschool to distribute my address and phone number on a class directory.

I give               /do not give                  permission for St. Paul’s Lutheran Preschool to take group/individual pictures of my child, to be used for the Preschool’s educational programs, public relations, and/or the St. Paul’s Lutheran Church/Preschool website.

 

                                                                                                                                                            Parent/ Guardian signature                                                                 Date

Registration

Student’s Name Birth Date
Siblings Age Sex

Other persons in the home_________________________________________________

Pets__________________________________________________________________
Additional Information:
Has your child experienced anything exciting or traumatic lately?

_____________________________________________________________________
How would you describe your child?

______________________________________________________________________
Do you have any concerns regarding behavior or development?

______________________________________________________________________
What do you expect out of your child’s preschool experience?

______________________________________________________________________

Family Physician Phone
Medical Insurance Provider
Policy Number Group ID
Policy Holder’s Name
Family Dentist Phone
Hospital preference
Does your child have any medical problems?
Does your child have any known allergies?

Does your child take any medications regularly?

St. Paul’s Lutheran Preschool has adopted the following procedures to provide care for your child if he/she becomes sick or injured at the school:
In case of emergency and/or the child needs medical or hospital care:
1. The school will call home. If there is no answer,
2. The school will call the mother, father or guardian. If there is no answer,
3. The school will call the other contacts numbers and the physician.
4. If none of the above answer, the school will call the ambulance, if necessary, to transport the child to a medical facility.
5. Based upon the medical judgment of the attending physician, the child may be admitted into the medical facility.
*The school will continue to call the parents, guardian, and/or physician until one is reached.

If I cannot be reached and the school authorities have followed the above procedures, I agree to assume all ambulance and medical expenses required to treat my child. I also, hereby, consent to any treatment, surgery, diagnostic procedure or anesthesia the attending physician deems necessary to treat the medical emergency.

Signed

Date

Student’s Name Birth Date
Address
Email Address _______________________________________________________________
Mother/Guardian Father/Guardian
Home phone Home phone
Work phone Work phone
Cell phone Cell phone

If neither parent/guardian can be reached, contact:
Name Relationship_______________Phone___________
Address
Is this person authorized to pick up your child? ____________

Name Relationship_______________Phone___________
Address
Is this person authorized to pick up your child? ____________

Name Relationship_______________Phone___________
Address
Is this person authorized to pick up your child? ____________

• There will be a non-refundable registration fee of $15.00 due at time of registration to reserve the space in the class.

• The first month’s tuition will be due in May. If we do not receive payment by then, we reserve the right to give the spot to another child.

• Starting in September, tuition will usually be due on the first Tuesday of each month. Payments will be handed directly to the student’s teacher. There will be a $15.00 late fee charged if tuition is not paid within seven days of due date.

• The last payment will be due in April. There are nine payments total.

• There will be no refunds for days missed. This includes vacations or sick days. We prepare for your child whether they are present or not.

Parent/ Guardian Signature Date