Registration Application

Child's Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Mother/Guardian Name *

First Name

Last Name

Phone Number *

(###)

###

####

Father/Guardian Name

First Name

Last Name

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your child currently receiving speech or OT services?

Yes

No

Does your child have an I.E.P.?

Yes

No

Parent Acknowledgements

Please acknowledge your agreement to the following statements

I understand that the registration fee is non-refundable, and must be paid in order to complete registration. No discounts will apply to registration fees.

I understand that I must submit a full vaccination record at the time of enrollment. Providence Church Preschool does not accept religious exemptions for vaccinations.

I understand that each of the nine (9) tuition payments is due from August 10, 2024 to April 10, 2025.

I understand that I am responsible for paying the processing fee if I pay online with a credit card, whether I pay monthly or yearly tuition.

I understand that a late fee of $25.00 will be added to my child’s tuition if payment is not received by the 10th of the month. I understand I will be responsible for paying bank charges as well as a $35.00 fee to Providence for any returned checks.

I understand that my child must be fully potty trained by September 1, 2024 to be in a 3’s or 4’s class.

I understand that repeated and/or egregious behavior, including biting, spitting, and any other aggressive behavior may result in school expulsion.

Date *

MM

DD

YYYY