2007-2008 ENROLLMENT AGREEMENT                                     PRESBYTERIAN CHILDREN’S CENTER

                                                                                                                 LESLEY JORDAN

Child's Name:                                               Date of Birth:                                  Date of Admission:
Address:                                                   City:                          Zip:                                Phone:
Father's Name:                                                                   Mother's Name:
Business Name:                                                                 Business Name:
Business Phone:                                                                Business Phone:
OTHER PHONE NUMBERS where parents may be reached while child is in care:
Give the name, address and phone # of person to call in case of emergency if parent/guardian cannot be reached:
 

I hereby authorize PCC to allow my child to leave ONLY with the following persons. Please list name and telephone of each. Children
will only be released to a parent or person designated by the parent/guardian after verification of ID.
   

     

 E-MAIL ADDRESS:____________________________________________________________________________________________

CHECK ALL THAT APPLY:

     FIELD TRIPS
     For children ages 3 through Kindergarten:   I hereby     give          do not give-consent for my child to participate in Field Trips.

   WATER ACTIVITIES
Toddlers through Kindergarten:                I hereby       give         do not give-consent for my child to participate in Water Activities.

I GIVE MY PERMISSION FOR PCC TO INCLUDE INFORMATION IN THE SCHOOL DIRECTORY CONCERNING MY CHILD'S NAME, ADDRESS, PHONE # & PARENT'S NAMES  ____________YES____________NO

     RECEIPT OF PARENT HANDBOOK:                      I have read and fully understood the Parent Handbook

          Acknowledgement of Policies                                I understand that PCC is no longer required to supplement my child's lunch.

                                                                                 I have read and fully understand the Discipline and Guidance Policies.

                                                                      

SPECIAL NEEDS STATEMENT
List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of:

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
PARENT/GUARDIAN_______________________________________________________ DATE____________________________

AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION:
In the event I cannot be reached to make arrangements for emergency care, I authorize PCC to take my child to:

Name of Physician: Address: Phone#
Name of Hospital: Address: Phone#

I give consent for PCC to secure any and all
necessary emergency care for my child.           ___________________________________________________
                                                                                   Signature-Parent or Legal Guardian

 

PARENT/SCHOOL RELATIONSHIPS
My child is registered for pre-school and/or daycare for the duration of the school year.
  Days in care_____________________________       Hours per day in care_______________________________
I agree to pay__________________per month each month of the school year. Tuition payments are due on the FIRST of each month and no later than the 10th of the month. Please add $10.00 late fee if tuition is paid on the 11th of the month or after. The budget is based on an annual basis. Withdrawal anytime during the school year will require a written notification to the Board of Directors. The request may or may not be approved.

 

CONTRACTUAL AGREEMENT

    1.   This agreement is a contract binding both school and parent.
    2.   This contract may be terminated by the SCHOOL at any time if the child is unable to adjust or participate in      
          group activities, and by the PARENT only with a written request to the Board of Directors stating a specific
          reason for withdrawal.
     3. If any of the above information changes, the parent will inform the Director and update this form as needed.

PARENT/GUARDIAN_______________________________________________DATE__________________