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