TUITION:


Initial _____ I have read and agree to the tuition policy below.
I understand that tuition and registration fees paid in advance are NON REFUNDABLE. I agree that payment
is to be drafted at time of registration and then on the 1 st of each month. Or the payment will be made in full at
the time of registration. Children are not enrolled in the ECC until the first month’s payment is received. If you
need to drop your child from the Program, a 30 day written notice is to be submitted to the Director.
Tuition is based on a yearly rate divided into 9 equal payments. Tuition is a set amount per month regardless
of the amount of school days. We do not give credits for days missed due to illness, vacations, or
cancellations due to weather or school holidays.
4s WATER PLAY: I hereby
give
do not give
This activity takes place on our playground for End of Year party.
-my consent for my child to participate in Water Activities:
splashing/wading pools
water table play
sprinkler play
Receipt of ECC Parent Handbook:
I did receive - my copy of the ECC Parent Handbook.
I acknowledge receipt of the facility’s operational policies including those for disciple and guidance. The can be printed online.
Class Directory Release: I hereby
give
do not give -my consent for my child to be listed in the class directory.
The undersigned Parent/Guardian agrees to let the name, address, email & phone number of the child listed below to be printed
in the classroom directory. The directory is sent home with the children in the classroom in order for the parents to contact each
other.
Fielder Church Early Childhood Center Visual Production Consent & Release:
I hereby
give
do not give - my consent to the following:
This includes any picture album the teachers may make for their class and any art projects requiring a picture.
The agreement below allows you to express your approval for your child’s name, picture, art, written work, voice, verbal
statements and/or portrait (video & still) (collectively, “Image/Statement”) to appear in ECC Visual Productions. These Visual
Productions may or may not personally identify your child. The Image/Statement may be used by ECC in Visual Productions in
subsequent years.
Consent and Release
The undersigned Parent/Guardian releases to Fielder Church Early Childhood the Image/Statement of the child listed below, and
the undersigned consents to ECC’s use of the Image/Statement as a part of ECC Visual Productions.
The undersigned Parent/Guardian understands and agrees that:
 No monetary consideration shall be paid by ECC for the use of the Image/Statement;
 The undersigned’s consent and release has been given without coercion or duress;
 The Image/Statement may be used in subsequent years by ECC.
The Consent and Release may be rescinded at any time with written notice to Fielder Church, 1323 W. Pioneer Parkway,
Arlington, TX 76013.
Parent/Guardian Signature:
__________________________________________
Office Use Only:
New Student_____ Former Class _____________
Class _____________
Admission Date ______________ Withdrawal Date _______________
Fielder Church Early Childhood Center Registration Form
Circle Days Attending: T/Th W/F M/W/F T-F M-F T/W/Th-4s only
(All days are 9:00 – 2:30)
Child’s Full Name: __________________________________________________ Date _______________________________
Name child goes by ____________________Birthdate: ___________ Age ______ Male __ Female __ Ethnicity _____________
Address ____________________________________________________________ Home# _____________________________
City ______________________________________________________________ Zip _________________________________
Mother’s Name: ________________________________ Cell# ________________________ work# ______________________
E-mail ___________________________________________________ Occupation ____________________________________
Father’s Name: ________________________________ Cell# _________________________ work#______________________
E-mail ___________________________________________________Occupation _____________________________________
Siblings & Ages: __________________________________________________ Potty trained? (3 years or older) Yes__ No__
Does your child have any allergies?___________________________________ Special needs?___________________________
If food allergy please complete the Food Allergy Emergency Plan.
Has your child been enrolled in any other pre-school or day care? __________________________________________________
Name of church currently attending: __________________________________________________________________________
Give the name, address and phone number of person to call in case of an emergency if parents cannot be reached:
____________________________________________________________________________________Relationship_________
I hereby authorize the ECC to allow my child to leave school ONLY with the following persons. Which may also be called in case
of an emergency. Please list name and telephone number for each. Children will only be released to a parent or a person
designated by the parent after verification of ID.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
4 Digit Security Code # _________ -This code will be used to verify parent over the phone calling to release a child to another
person not on the pickup list.
Authorization for Emergency Medical Attention: In the event I cannot be reached to make arrangements for emergency
medical care, I authorize the person in charge to take my child to:
_______________________________________________________________________________________________________
Name of Physician
Address
Phone#
_______________________________________________________________________________________________________
Name of Emergency Medical Care Facility
Address
Phone#
Initial ______ I give consent for the facility to secure any and all necessary emergency medical care for my child.