Registration Form 2024-2025 School Year Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Child's Name * First Name Last Name Child's Birth Date * Child's Age(s) on August 31, 2024 * Class Choice * Infants (Must be 3 months by August 31, 2024) Toddlers (Must be 1 by August 31, 2024) Twos (Must be 2 by August 31, 2024) Threes (Must be 3 by August 31, 2024) Pre-K Fours (Must be 4 by August 31, 2024) Fives/Readiness (9am-1pm) Days Requested * Infant/Toddler 2 Days (You Choose the Days) Infant/Toddler 3 Days (You Choose the Days) Infant/Toddler 4 Days (You Choose the Days) Infant/Toddler 5 Days (You Choose the Days) 3 Days - Twos/Threes (Monday, Wednesday, Friday) 5 Days - Twos/Threes (M-F) 5 Days - Fours (M-F) 4 Days - Fours (M-Th) 5 Days - Fives/Readiness (M-F) Infants/Toddlers Which Days to Attend? Add Lunch Bunch Option * Extends day until 1pm. Lunch Bunch fees are paid by the month and added onto monthly tuition. Add Lunch Bunch (9am-1pm day) No Lunch Bunch (9am-12pm day) Required Lunch Bunch for Fives Parent Information Parent/Guardian #1 * First Name Last Name Parent/Guardian # 1 Phone * (###) ### #### Parent/Guardian #2 First Name Last Name Parent/Guardian # 2 Phone * (###) ### #### Parents Are * If there is a custody order, a copy of the order is required to be on file in our office. Single Together Married Separated Divorced Child Lives With: * Emergency Info Emergency Contact #1 * Parents/guardians will always be contacted first. These emergency contacts are in addition to parents/guardians. First Name Last Name Emergency Contact #1 Phone * (###) ### #### Emergency Contact #2 * First Name Last Name Emergency Contact #2 Phone * (###) ### #### Do you give permission for emergency contacts to pick up your child? * Yes No Only Contact #1 Only Contact #2 Financial Policies Registration fee is due at the time of registration and is nonrefundable. All accounts must be current to register for the upcoming school year. Tuition is divided into 9 equal payments and is not based on the number of days in a month. Tuition is paid one month in advance, due by the 10th of every month (September due Aug. 10, October due Sept. 10, etc.). Invoices are sent via email. We prefer tuition to be paid through ACH automatic drafts, but we will also accept cash (exact change) and check. You will receive an ACH draft form in May to set up or confirm account details. Late tuition payments are subject to a late fee of $30 if paid after the 10th of the month. After the 15th, the fee increases to $55. After the 20th, your child will not be able to return to school until the fees are paid. Fees are added monthly until the late tuition is paid. Returned check/ACH payments are subject to a fee of $30. Two returned checks/ACH payments will result in having to pay by certified check or cash. Travel is an important part of our lives. However, we do not make tuition payment exceptions due to travel. Monthly tuition payments are required to hold your child’s space. Health forms and immunization records are required every school year, even for children who attended the prior year. Forms not returned by 30 calendar days after the start of school are subject to a $20 fee. After 60 calendar days, the fee increases to $50. Late pick ups at the regular school day (after 12:10 pm) or after lunch bunch (after 1 pm) will result in a $10 late fee for the first incident, $15 for the second incident, and $20 for the third. After 3 late lunch bunch pick ups, the child will no longer be able to stay for lunch bunch. For late pickups that occur more than 10 minutes after the late cut off, the fee for the incident automatically increases to $20, and $5 will be added to that fee for each additional 5 minutes of wait time. Please note that state law forbids us from keeping children more than 4 hours – please help us comply with this by being timely with pickup. Withdraws or changes in schedule must be made in writing with 30 days notice. Registration fee is non refundable. Tuition during the 30 day period must still be paid unless we are able to fill the vacant spot. Hardships do arise. Please contact our office if you are experiencing a financial or medical hardship as it relates to tuition to discuss alternative arrangements. I understand the information regarding financial policies for New Philadelphia Moravian Preschool. I have read and understood the information on this sheet. I understand the information regarding financial policies for New Philadelphia Moravian Preschool. I have read and understood the information on this sheet. * Please type your full name to acknowledge that you have read and agree to the financial policies stated above. Date MM DD YYYY Student Information Tell us about your child! Any major fears, special interests, or favorite activities? * Has your child been in a preschool setting before? * Yes No Is your child currently under a doctor's care or on daily medication? If yes, please explain. History of significant disease or recurrent illness? If yes, what and when? Any disabilities or developmental delays? If yes, please explain. Is your child receiving any of the following: speech therapy, physical therapy, occupational therapy, and/or counseling? If yes, please explain. Any food allergies or dietary limitations? (If a food allergy is present, an action plan must be completed by child's physician) Please list any serious allergies. (If your child carries an Epipen/Auvi-Q at school, an action plan must be completed by child's physician) Does your child have any of the following conditions? Asthma (If child carries an inhaler at school an action plan must be completed by physician) Diabetes Hepatitis Epilepsy/Seizure Disorder Hearing Issues Heart Condition Vision Issues Blood Disorder Other If yes to any of the immediate above, please explain Name of Pediatrician/Practice * I am registering my child at New Philadelphia Moravian Preschool. I understand this form is valid once signed and submitted. * First Name Last Name Date MM DD YYYY Thank you for submitting registration for the 24-25 school year at New Philadelphia Moravian Preschool! Please look out in your email soon for next steps and information regarding the registration fee. Your spot is not secured until the registration fee has been paid.Please email or call our office regarding any registration questions or concerns. Thank you!
