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Student Enrollment
Student Enrollment
admin
2023-06-27T16:37:20-04:00
Child's Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Child's Gender
(Required)
Male
Female
Child's Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Parent 1 Information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Parent/Guardian address ONLY IF different than child's.
Street Address
City
State / Province / Region
ZIP / Postal Code
Business Address
(Required)
Street Address
City
State / Province / Region
Parent 2 Information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Parent/Guardian address ONLY IF different than child's.
Street Address
City
State / Province / Region
ZIP / Postal Code
Business Address
(Required)
Street Address
City
State / Province / Region
Program of Interest
Please Select one
(Required)
2-Day 2s - T/Th, 9 am -12 pm
3-Day 2s - M/W/F 9 am -12 pm
3-Day 3s - T/Th/F, 9 am -12 pm
3-Day 4s - M/W/F, 9 am-12 pm Sept-Dec/9am - 1:30 pm Jan-May
4-Day 4s - M/W/Th/F, 9 am -12 pm Sept-Dec/ 9 am - 1:30 pm Jan-May
4-Day 5s M/T/W/F, 9 am - 1:30 pm
5-Day 5s M - F, 9 am - 1:30 pm
Where did you first learn of our Preschool and its programs?
(Required)
We’re a returning family
Word of Mouth (relative, friend)
Appeared in Google Search
Social Media (ie Facebook Page or Moms of Fairfield Post)
Community Resources (ie Fairfield Library Website or Fairfield Moms Website)
Community Event
Permission Form
I/We give permission for my child to use all play equipment and participate in all activities at Presbyterian Nursery School (Presby Kids).
(Required)
Yes
I/We hereby grant permission for my child to access indoor and outdoor spaces located at the same address as the licensed facility. I acknowledge that some of these areas are licensed, inspected, and approved by the Office of Early Childhood (OEC), while others are not. I further grant permission for my child to use all such areas under the supervision of the school staff, understanding that appropriate safety measures will be in place.
(Required)
Yes
I/We understand that the school may photograph or videotape children for promotional purposes (website, social media, printed materials, etc.).
(Required)
Yes – Opt In: I/We grant permission for my child to be photographed or videotaped and release the school from any claims related to such use.
No – Opt Out: I/We do not grant permission for my child to be photographed or videotaped for any school promotional purposes.
I/We grant permission for Presby Kids staff to take necessary steps to provide emergency medical treatment for my child, including administering first aid, contacting a parent/guardian or physician, calling an ambulance if needed, or transporting my child to a hospital or urgent care. I/We understand that any expenses incurred will be the responsibility of the child’s family.
(Required)
Yes
I/We hereby grant permission for my child to undergo evaluations conducted by members of the Presbyterian Nursery School (Presby Kids) team, as deemed appropriate by the staff.
(Required)
Yes
I/We grant permission for my child's teacher and the Director to contact my child's previous preschool and current or prior service providers.
(Required)
Yes
No
Parent Agreement
I acknowledge that I have reviewed the Program Overview section of the Parent Handbook and agree to comply with the policies outlined therein, including, without limitation, those related to Tuition & Payments and Required Forms.
(Required)
Yes
I acknowledge that I have reviewed the Health, Safety, & Emergency Preparedness section of the Parent Handbook and agree to comply with the policies outlined therein, including, without limitation, those related to Reporting Absences, Illness Guidelines, & Vaccinations.
(Required)
Yes
I acknowledge that I have reviewed the Supervision, Behavior Management, and Abuse section of the Parent Handbook and agree to comply with the policies outlined therein, including, without limitation, those related to discipline. I further acknowledge that the facility’s methods for managing child behavior have been explained to me, and I understand and accept these practices as part of my child’s enrollment.
(Required)
Yes
I acknowledge the necessity of keeping current contact information on file for Parents/Guardians, Emergency Contacts, and Authorized Pickup Contacts, and I agree to provide updates to the school promptly as needed.
(Required)
Yes
Standard Binding Tuition Agreement
I understand that a $150 Enrollment Fee and one month’s tuition are due at the time of enrollment. The second tuition installment is due by April 20th, with the remaining balance, or next payment, due on September 1st. Subsequent semi-annual or installment payments are due on the first day of the appropriate month thereafter.
(Required)
Yes
I acknowledge that Presby Kids does not issue tuition invoices. I understand that I am solely responsible for adhering to the tuition payment schedule and agree to consult the tuition schedule available on the Presby Kids website to ensure timely payment.
(Required)
Yes
I understand that I remain responsible for the year’s tuition if my child withdraws, with exceptions considered only for extraordinary circumstances, such as a justified request by Presby Kids or verified medical reasons preventing program participation.
(Required)
Yes
I acknowledge that any bank fees, returned payment charges, or other financial penalties incurred by the school due to payment issues will be the responsibility of the parent/guardian of the student.
(Required)
Yes
I accept the conditions above and register my child to the following Presby Kids Program
(Required)
2-day 2s Class
3-day 2s Class
3-day 3s
3-day 4s
4-day 4s
4-day 5s
5-day 5s
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)
Annually
Semiannually
9 Installments
Typing your name and date in the following field constitutes a binding digital signature
(Required)
Presby Kids Emergency Form
Child's Name
(Required)
First
Last
Parent 1 Name
(Required)
First
Phone Number
(Required)
Parent 2 Name
(Required)
First
Phone Number
(Required)
Emergency Contacts (Other than parents) -Individuals authorized to pick up my child AND to be contacted in case of an emergency
Individuals authorized to pick up my child AND to be contacted in case of an emergency if the parents/guardians cannot be reached.
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
Allergies & Health Concerns
Please indicate severe allergies and health concerns that may required emergency medication to be kept at school.
Does your child have life-threatening allergies, emergency medications, or other health concerns?
(Required)
Pediatrician Name
(Required)
Pediatrician Phone Number
(Required)
Authorized Pickup Contacts -Individuals authorized to pick up my child but NOT to be called in the event of an emergency
The following individuals are authorized to pick up my child from school if I am unable to do so. These contacts WILL NOT be called in the event of an emergency.
Name and relationship to child. What does your child call them?
Name and relationship to child. What does your child call them?
Name and relationship to child. What does your child call them?
Consent
I give permission to Presbyterian Nursery School to take necessary emergency measures for my child’s safety. In a medical emergency, my child may be taken to Bridgeport Hospital or another facility as determined by emergency personnel. I understand that emergency services may be contacted before I am notified and that all related costs are my responsibility.
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