Student Enrollment - Presby Kids

Child Information

Child's Name(Required)

First Last

Child's Age(Required)

Date of Birth(Required)

Child's Gender(Required)

Address(Required)

Street Address City State / Province / Region

Parent 1 Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Business Address(Required)

Street Address City State / Province / Region

Parent 2 Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Business Address(Required)

Street Address City State / Province / Region

Program of Interest

Please Select one(Required)

Where did you first learn of our Preschool and its programs?(Required)

Future Children Attending Presby - Names and Date of Births

Consent(Required)

I agree to pay a $150 Registration Fee along with one month's tuition.

Emergency Information

Person/s Responsible for Child?(Required)

Emergency Contacts

The following persons are authorized by me to pick up my child from school if I am unable to do so AND may also be called in an emergency if the parent/guardian cannot be reached. (Please list at least 2 local names and numbers - not the child's parents).

Name and relationship to child. What does your child call them?(Required)

Phone Number(Required)

Name and relationship to child. What does your child call them?(Required)

Phone Number(Required)

Name and relationship to child. What does your child call them?

Phone Number

Authorized Pickup Contacts

The following persons are authorized by me to pick up my child from school if I am unable to do so. (Please list at least 2 local names and numbers - not the child's parents).

Name and relationship to child. What does your child call them?(Required)

Phone Number(Required)

Name and relationship to child. What does your child call them?(Required)

Phone Number(Required)

Name and relationship to child. What does your child call them?

Phone Number

Pediatrician Name(Required)

Pediatrician Phone Number(Required)

Dentist Name(Required)

Dentist Phone Number(Required)

Does your child have allergies? If so, is an Epi-Pen required?(Required)

Does your child have any general health concerns?

Consent

I give permission to the Presbyterian Nursery School to make whatever emergency (e.g., first aid, disaster evacuation) measures as judged necessary for the care and protection of my child while under their direct supervision. In case of a medical emergency, I understand that my child will be transported to St. Vincent’s Medical Center by the local emergency resource (Police or Rescue Squad) if they deem it necessary. However, it is understood that the emergency resource will determine which medical facility/hospital to transport the child to depending on the nature of the emergency. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, the child’s physician and/or other adult acting on the parent’s behalf. The child will be transported at the expense of the parents/guardian or the parent’s/guardian’s Insurance Company.

Permission Form Information

1. I/We grant permission for my child to use all the play equipment and participate in all activities while at Presbyterian Nursery School (PNS).(Required)

Yes

2. I/We grant permission for my child to leave the building and participate in on-site field trips under the supervision of PNS staff.(Required)

Yes

3. I/We grant permission for my child to be photographed or videotaped for usage in the school’s marketing and publicity which can include but not limited to website, promotional materials, internet and social media.(Required)

Yes

4. I/We grant permission for my child to be evaluated by the teaching staff.(Required)

Yes

5. I/We grant permission for the PNS or church staff to take whatever steps may be necessary to provide emergency medical treatment. These steps may include but are not limited to administer first aid, contact child’s parent/guardian or physician, call an ambulance if necessary, transport child to emergency hospital or walk-in if parent advises or is not reachable. Any expense incurred due to a medical emergency will be the responsibility of the child’s family.(Required)

Yes

6. I/We grant permission for First Presbyterian Church of Fairfield to email me/us with information related to church events.(Required)

Yes

Parent Agreement

I have read and reviewed the following material from the Presbyterian Nursery School: Our discipline policy has been discussed prior to enrollment and I have read the policy in the Parent Handbook. I acknowledge and accept the Presbyterian Nursery School Policies and agree to abide by all policies.(Required)

Yes

I have read and reviewed the following material from the Presbyterian Nursery School: Tuition Agreement, Health Form Requirements, Permission Form, and Parent Handbook.(Required)

Yes

Please indicate all contact information you would like included. If you do not want to have your family information in our school directory, please indicate below.

Parent #1 Phone Number

Parent #2 Phone Number

Parent #1 Email Address

Parent #2 Email Address

Include Only my child's name and Parent names

Binding Tuition Agreement

Presby Kids happily accepts your child into our school community for the upcoming academic year. Children are accepted for the entire school year or for the remainder of the school year if enrolled after the opening date.

I understand that I am responsible for the balance of the year’s tuition in the event of withdrawal. Extraordinary circumstances may be considered for the following reasons: the specific request from Presby Kids with just cause, or for verified medical conditions which preclude participation in the program.(Required)

Yes

I understand that a $150 Enrollment Fee & one month’s tuition is due at enrollment and the second tuition installment is due by June 1st. The balance, or next payment, is due on September 1st, and semi-annual or installment payments are due on the FIRST of the appropriate month thereafter.(Required)

Yes

Any bank fees incurred by the school will be passed to the parent/guardian responsible for the student.(Required)

Yes

I accept the conditions above and register my child to the following Presby Kids Program(Required)

Tuition Schedules

Please click here to review the tuition schedules.

Tuition Schedule Agreement(Required)

Yes, I agree to the outlined tuition schedule.

I also agree to and take responsibility for the payment of the fees as stated on page two of this tuition agreement with payments scheduled as follows:(Required)

Typing your name and date in the following field constitutes a binding digital signature(Required)