Childcare Registration Form printable pdf download

Childcare Registration Form

2016-2017

Child’s Name ________________________________________ Birth Date __________________

Street _____________________________City, State, Zip _______________________________

Parent Responsible for Payment ___________________________________________________

Cell Phone ( ) ______________________Home Phone ( )____________________________

Business Phone ( ) ______________________Email __________________________________

Best Number to use During Childcare Hours __________________________________________

Which Preschool class is your child enrolled in? _______________________________________

Requested Childcare Schedule

Child must be enrolled in Community Preschool. Childcare fees are in addition to Preschool tuition.

Childcare Weekly Rate (6:30 am – 6:00 pm, 5 days/week) Price

___ 3‐5 year old

$130/week

___ 2‐3 year old

$145/week

Childcare Single Session Options

Price

___Before School (6:30‐9:00 am)

$50/week

___After School A (12:00‐3:00 pm)

$60/week

___After School B (12:00‐6:00 pm)

$95/seek

Childcare Flexible Rate

Price

___Any time (capacity‐dependent)

$5/hour

*must be enrolled in Community Preschool and Childcare

___Registration Fee of $60 will reserve your childcare enrollment.

Due to regulations regarding child‐teacher ratios, space is limited.

Registration Fee Paid on _______________(date) ________________(amount)

A 10% discount will be given to families with two or more children enrolled.

Childcare fees are due on Monday for that week of care.

(over)

Childcare Registration Form