2017-18 Application
Child’s Name:_____________________________Gender____Date of Birth:__________________
Home Address:______________________________________Home Phone:__________________
______________________________________
Elementary School your child will attend:_____________________Kindergarten entry year_____
Parent/Guardian Information:
Name:_______________________________
Mobile:____________________Email:__________________________
Name:_______________________________
Mobile:____________________Email:__________________________
Does your child have any allergies or medical conditions? Yes_______No________
If yes, please explain:_______________________________________________________________
________________________________________________________________________________
Is your child receiving any Early Intervention or CPSE services at the current time? Yes____No____
If yes, please explain:_______________________________________________________________
________________________________________________________________________________
How did you hear about our school?___________________________________________________
Play Care admits children of any race, religion, color or ethnic origin.
Applications are accepted on a first come, first served basis
Please mark your desired days in each program below:
Morning sessions (9:15am -12pm) Monday - Friday open to 18 months – 5 years of age
Families can choose any combination of days.
Monday
Tuesday
Wednesday
Thursday
Friday
Afternoon sessions (12 -2:30pm) Tuesday, Wednesday or Thursday for children 3 years of age by
September 1, 2017. A minimum of 4 children required for a class to open. Children may enroll for
only the afternoon or can add the afternoon to a morning session.
Tuesday
Wednesday
Thursday
Ready for K (12- 2:30pm) on Tuesdays, Wednesdays and/or Thursdays for children 4 by December
31, 2017. Morning session attendance on selected day is required. This program provides a full
day 4’s experience.
Tuesday
Wednesday
Thursday
Application Fee: $100 per family
Tuition Deposit: $100 per Morning session/Afternoon session/Ready for K session selected above
must accompany this application form. This deposit will hold your child’s place for the 2017--2018
school year and will be applied toward the total tuition. This deposit is non-refundable.
The remaining tuition is paid in two equal payments (September 1, 2017 and January 1, 2018.)
Total Enclosed: ($100 Application Fee plus applicable Tuition Deposit): ___________________
I, the undersigned, have read the above information, and I understand that the Application Fee
and Tuition Deposits will not be refunded for any reason.
Signature: ______________________________________________ Date: __________________