Dear Parents of Little Lambs,
Enclosed please find a registration form for the 2015-2016 school
year to be filled out and returned with your registration fee as soon
as possible. This will ensure a place for your child for September
placement. If you have a preference for a certain session, please
return the papers quickly because placement is on a firstcome/first-served basis.
Please note on the registration form the many options available to
your student. We will attempt to accommodate your wishes as
much as we are able, but please know that these offerings are
subject to enrollment. We will contact you as soon as possible if
we need to withdraw any of these programs.
God bless you.
Sincerely yours,
Val Wojnicki
Director
2015-2016
REGISTRATION FORM
ST. MARY’S LITTLE LAMBS PRESCHOOL
CHILD’S NAME _______________________________
(Please print clearly)
DATE OF BIRTH ____________
Male____ Female ____
FATHER’S NAME __________________ OCCUPATION________________________
MOTHER’S NAME _________________ OCCUPATION ________________________
MAILING ADDRESS ________________________________________________
_____________________________________ Zip __________
E-MAIL ADDRESS ___________________________________________
HOME PHONE NUMBER _________________________________
MOTHER’S CELL PHONE NUMBER _________________________________
FATHER’S CELL PHONE NUMBER _________________________________
OTHER CHILDREN AT HOME (names, ages, relation)
____________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Emergency Contacts (names and phone numbers):
Local ____________________________________________________
Name
Phone
Cell Phone
Other ____________________________________________________
Name
Phone
Cell Phone
Signature ______________________________
For Office Use Only:
Date Received _______________
1st Time Registration Fee
$50 _________
Returning Year
Registration Fee
$35 _________
Class Assignment __________
For Archdiocesan census purposes only, please indicate the
following:
1. ________ Catholic or ________ Non-Catholic
2.
______American Indian ______Asian _____ Black
______ Hispanic ______Pacific Islander
______ White _______ Multiracial
BACKGROUND INFORMATION
Does your child have any allergies to food? __________________________________________
Other allergies? _________________________________________________
Does your child have any health problems that we should be aware of? ___________________
Please explain __________________________________________________________
Is there anything else you would like us to know about your child? vision, hearing, speech, eating
problems, unusual abilities or disabilities? Is your child receiving any Early Intervention or services?
Does your child have any special interests?
_____________________________________________________________________________________
_____________________________________________________________________________________
AUTHORIZATIONS
EMERGENCY AUTHORIZATION
I hereby give consent to the school to have medical or surgical treatment of an emergency nature given
to my child or children while at school or under my care as school personnel. I understand that every
effort will be made to notify me as soon as possible.
Child’s Physician: Name __________________________________ Office Phone ____________
Emergency Hospital Preference
_______________________________
_______________________________
Parent/Guardian
CLASS LISTS
St. Mary’s Little Lambs Preschool distributes a class list that is furnished to all families in that class.
The list includes address, home phone and e-mail address. I authorize release of this information to
other class members.
__________________________________
Parent/Guardian
PHOTO RELEASE
I understand that occasionally St. Mary’s Preschool functions and programs are covered by local news
agencies. In addition, photos may appear in the St. Mary’s Church weekly bulletin and on the school
web site. Last names will never be used in print to identify your child in a picture. For safety reasons,
no photos of the children will be placed on Facebook. St. Mary’s Preschool has my permission to
release pictures of my child for the reasons mentioned above.
________________________________________
Parent/Guardian
ST. MARY’S LITTLE LAMBS PRESCHOOL
Programs for Three-Year Olds
Your child must be 3 by December 1, 2015.
Days
Time
Monthly Fee
Morning
_________________ Tuesday, Thursday
9:00-11:30
$145.00 monthly
Afternoon
_________________ Tuesday, Thursday
12:00-2:30
$145.00 monthly
Programs for Four-Year Olds
Your child must be 4 by December 1, 2015.
Days
Mornings
________________
Time
Monthly Fee
Mon., Wed., Fri.
9:00 - 11:30
$170.00 monthly
Afternoon
_________________ Mon., Wed., Fri.
12:00 - 2:30
$170.00 monthly
Mornings
_________________ Monday through Friday 9:00 - 11:30
$300.00 monthly
Afternoon
_________________ Monday through Friday
12:00 – 2:30
$300.00 monthly
_________________ Mon., Wed., Friday
9:00 – 2:30
$310.00 monthly
Kindergarten Enriched Program
Your child must be 5 by December 1, 2015.
Days
Mornings
________________
Mon., Wed., Fri.
Afternoon
___________________Mon., Wed., Fri.
Time
9:00-12:30
12:00– 2:30pm
Monthly Fee
$175.00 monthly
$175.00 monthly
ST. MARY’S LITTLE LAMBS PRESCHOOL
FINANCIAL INFORMATION
1. Registration Fee: A $50 fee is payable upon registration. This fee is non-refundable
and will apply to a first time registration at our school. Subsequent years for the same
child will be a $35.00 registration fee. All registration fees include an activity fee.
2. Security Tuition: One month’s tuition is payable by July 1, 2015. Please note that
this security tuition will be applied to the June 2016 tuition. If a student withdraws
from the program any time up to October 10th, a refund will be prorated, and that
amount will be refunded. After October 10th, the security tuition will not be refunded.
3. Monthly Tuition: Monthly payments are due by the first of each month. The
monthly tuition will not be prorated due to illness, holidays, snow days, vacations or
cancellations. All checks are made payable to:
St. Mary’s Church
3-year old Program (2 half days A.M. or P.M.)
4-year old Program (3 half days A.M. or P.M.)
4-year old Program (5 half days A.M. or P.M.)
4-year old Program (3 full days)
Kindergarten Enriched (3 half days am/pm)
$145.00 per month
$170.00 per month
$300.00 per month
$310.00 per month
$175.00 per month
If you have a special concern about your child’s placement, please speak to the
Director, Valerie Wojnicki.
4.
Returned checks: All returned checks are subject to the service charge as indicated
by our bank.
WITHDRAWAL POLICY
St. Mary’s Little Lambs Preschool reserves the right to remove a child from the program
when tuition payments are delinquent by two months. If you are experiencing difficulty with
the tuition payments, please bring that to the attention of the Director.
I have read and understand the above Financial Information and Withdrawal Policy.
This agreement is made on ______________________ between St. Mary’s Little
(date)
Lambs Preschool and_____________________________________________.
(Please Print)
(Parent/Guardian)
________________________________
Parent
________________________________
Director