2015-2016 APPLICATION FORM
CHILD’S NAME:
MALE FEMALE
First
BIRTHDATE:
Last
(month/day/year) Age (in months) as of 09/01/15:
mos.
DAY PREFERENCES
Please rank your preferences…We cannot guarantee your choice of days
Ages 6 mos.-12 mos.
Tues/Thurs
Ages 19 mos-3 years
Mon/Wed
Age 3+ (birthday between 9/2011 and 5/2012)
Ages 13-18 mos
Tues/Thurs
Mon/Wed/Thurs
______ Mon/Wed
Mon – Thurs
Placement of your child in his/her classroom is at the discretion of the Director.
ADDRESS:
CITY, STATE:
ZIP CODE:
HOME PHONE:
MOTHER’S NAME:
FATHER’S NAME:
OCCUPATION:
OCCUPATION:
WORK PHONE:
WORK PHONE:
CELL PHONE:
CELL PHONE:
PRIMARY E-MAIL:
E-MAIL:
Child lives with:
Both Parents
Mother
Father
Guardians
ALTERNATE ADDRESS (if applicable):
CHURCH AFFILIATION:
I have read and understand the 2015-2016 Application & Tuition Policies.
PARENT SIGNATURE:
DATE:
---------------------------------------------------------------------------------------------------------------For Office Use Only
Date Received: ___________
Class:
Fee Ck #
_____ Ck Date:
__ Amount: ________ Postcard Mailed:
Waiting List: __________________
THE EPISCOPAL CHURCH OF THE GOOD SHEPHERD
PARENTS’ DAY OUT
11122 MIDWAY ROAD
DALLAS, TX 75229
214-351-4419 anne.hobbs@gsecd.org
www.goodshepherdpdo.org
Anne Hobbs-Director
2015-2016 APPLICATION & TUITION POLICIES
1. Enrollment for our program (September to May) is held in January/February. Children are
enrolled in the following priority:
A: Children and siblings of families currently enrolled
B: Parishioners of the Episcopal Church of the Good Shepherd
C: New families
Among each category, enrollment is on a first-received basis.
2. A $200 non-refundable application fee is required with your application.
3. When you apply you have agreed to pay the entire nine months tuition. If you must
remove your child from the program, the office must be informed in writing at least 30
days in advance. You will be responsible for tuition through your child’s final day.
4. Tuition is paid as follows:
A. September tuition and supply fee is due in the PDO office by May 10, 2015.
B. Monthly tuition payments for the remainder of the school year will be due September
1, 2015 through April 1, 2016.
C. Tuition may be paid by the month, semester, or in full for the year.
5. Parents’ Day Out is an outreach ministry of The Episcopal Church of the Good Shepherd.
We are non-profit and self-supporting. Our program depends on your prompt tuition
payments. Tuition is due on the 1st of each month and is considered late after the 10th of
each month. A $25.00 late fee will be applied to a late tuition payment. Checks are to
be made out to GSPDO with your child’s name and the month(s) you are paying for
written in the memo section. Failure to pay will result in immediate removal of the child
from the program.
Tuition and fees for the 2015-2016 school year are as follows:
Tuition Fee:
$ 250.00 month for 2x week
$ 375.00/month for 3x week (Butterfly class only)
$ 500.00/month for 4x week (Butterfly class only)
Application Fee:
$ 200.00
Annual Supply Fee:
$ 100.00 2x week
$150 - 3x week
$200 – 4x week
Late Tuition Fee:
$ 25.00
Placement of your child in his/her classroom is at the discretion of the Director.