3519 Easter Stanley Court, Tallahassee, Florida 32308
Office (850)-921-KIDS (5437)
Fax (850)-921-4734
The Preschool at Evening Rose is a program operated by the Children's Home Society Early Learning Initiative, LLC.
Application for Enrollment
Program Information
Please check the box next to the program in which your child is enrolling.
Regular Program
Full-time
Part-time (M,W,F)
Hospital Contract
Full-time (45 - 67.5 hrs/wk)
Voluntary Pre-K*
Full-time Wrap Around
Part-time (30 - 41 hrs/wk)
Part-time Wrap Around
Part-Time (T, TH)
VPK Only
Before/Afterschool
* For School Year VPK enrollment, child must turn four years old by September 1st.
** Summer VPK is for children going to Kindergarten in the Fall who have not attended a VPK program previously.
Student/Family Information
Child's Name:
Date of Birth:
Gender: M
F
(Circle One)
Father/Stepfather/Guardian Name:
(circle one)
Address:
Home Phone:
City
State
Zip
Cell Phone:
Place of Work:
Work Phone:
Occupation:
Email:
Mother/Stepmother/Guardian Name:
(circle one)
Address:
Home Phone:
City
State
Zip
Cell Phone:
Place of Work:
Work Phone:
Occupation:
Email:
With whom does the child reside?
Both Parents?
Mother?
Father?
Guardian?
Who is responsible for tuition/fees?
Both Parents?
Mother?
Father?
Guardian?
Name and Age of Siblings:
Office Use Only
WAIT LIST
Date Application Submitted:
Proposed Date of Enrollment:
Date Wait List Fee Submitted:
ENROLLMENT
Date Application Submitted:
Proposed Date of Enrollment:
Date Registration Fee Submitted:
Page 1 of 5
Enrollment and Tuition Agreement
This agreement is made and entered into this _______day of_________20__, by and between The Preschool at Evening
Rose, a program operated by the Children's Home Society Early Learning Initiative, LLC, hereinafter referred to as “The
Preschool at Evening Rose”, whose address is 3519 Easter Stanley Court, Tallahassee, Florida 32308 and
__________________________________hereinafter referred to as Parent(s)/Guardian(s). This agreement is a "monthto-month" contract. Information contained within this agreement (including tuition fees) can be modified with at least two
weeks notice.
I.
Both parties, The Preschool at Evening Rose and the Parent/Guardian agree as follows:
Registration Fee: The Parent/Guardian is responsible for paying a Registration Fee of $150.00 at the time of
enrollment. This is a non-recurring fee paid once at the time of enrollment for each child being enrolled and is nonrefundable under any circumstances.
Regular Tuition: The Parent/Guardian is responsible for paying the monthly tuition as well as all applicable material
fees each semester. Tuition payment is due in advance, no later than the 20th of the preceding month. A late fee of $30
will be assessed after the 25th of the month plus $5 for each additional late day after the 25th. If tuition is not paid by the
1st of the month, the child may not return to The Preschool at Evening Rose until all tuition and applicable late fees have
been paid in full.
 Full-Time: defined as care offered Monday - Friday between 6:45 am - 5:45 pm.
 3-Day Part-Time: defined as care offered Monday, Wednesday and Friday between 6:45 am - 5:45 pm.
 2-Day Part-Time: defined as care offered Tuesday and Thursday between 6:45 am - 5:45 pm.
 Before and/or Afterschool: defined as care offered before and/or after Leon County School Pre-K.
Note: Tuition fees change when your child has
successfully completed transition to the next
room/group. Our staff will evaluate your child
based on development and age to determine the best
time to begin transition. Children identified as ready
for transition will be moved to a new room/group as
space becomes available.
Monthly Tuition Fees by Age Group
1 Year Old
2 Year Old
3 & 4 Year
Room
Room
Old Group
Full-Time
$800
$775
$750
3-Day Part-Time
$600
$600
$600
2-Day Part-Time
$400
$400
$400
Before/Afterschool
$275
NOTE: All children enrolled for "Regular Tuition", are subject to standard early drop-off and late pick-up fees. See page 5 of this document for
detailed early drop-off and late fee information.
Hospital Tuition: The Parent/Guardian is responsible to have tuition payroll deducted on a bi-weekly basis at a rate of
$4.00 per hour as well as pay all applicable materials fees each semester.
 Full-Time: Full-time care is defined as a minimum of 45 hours of care and up to 55 hours maximum
allowable for a five (5) day period. Any hours beyond the 55 hour maximum will be at a rate of time and a
half the regular tuition rate ($4.95 per hour).
 Part-Time: Part-time care is defined as a minimum of 30 hours of care and up to 41 hours maximum
allowable for a one week period. Any hours beyond the 41 hour maximum will be at a rate of time and a half
the regular tuition rate ($4.95 per hour).
VPK Tuition: The Parent/Guardian is responsible for paying the monthly tuition based on their child's VPK program
(see below). Tuition is due no later than the 20th of the preceding month. A late fee of $30 will be assessed after the 25th
of the month plus $5 for each additional late day. If tuition is not paid by the 1st of the month, the child may not return to
The Preschool at Evening Rose until all tuition and applicable late fees have been paid in full.
 Full-Time Wrap-Around: Full-time Wrap-Around care is defined as a child eligible for care Monday - Friday from
6:45 am - 5:45 pm. Full-time Wrap-Around tuition is $550 per month.
 Part-Time Wrap-Around: Part-time Wrap-Around care is defined as a child eligible for care Monday - Friday from
6:45 am - 2:30 pm. Part-time Wrap-Around tuition is $380 per month.
 VPK Only: VPK Only care is defined as a child eligible for care Monday - Friday from 9:00 am - 12:00 noon. There
is no additional tuition for VPK Only.
NOTE: All children enrolled for "VPK Tuition", are subject to standard early drop-off and late pick-up fees. See page 5 of this document for
detailed late fee information.
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II.
Grounds for Dismissal: The following conditions or occurrences may constitute grounds for the
immediate termination of the child’s enrollment privileges:
o
o
o
o
o
Failure to pay the tuition and/or fees as required by section I above at the required time for the enrolled child
at The Preschool at Evening Rose.
Failure to submit required forms by given deadlines.
Failure to consistently drop off and pick up as required by section I.
Any behavior by the parent that is non-supportive, disrespectful, and/or threatening to the faculty and staff of
The Preschool at Evening Rose.
Any behavior by the child that is disruptive, harmful to self, other children or our teachers and staff could
constitute grounds for dismissal. It is the policy of The Preschool at Evening Rose to work diligently with
all children and their families to help them to learn to manage appropriate behavior while at the preschool.
However, if the behavior is on-going with little to no improvement, termination of enrollment may be
necessary.
Discipline Policy
The Preschool at Evening Rose shall utilize discipline techniques that foster kindness and respect. Discipline
will not be severe, humiliating, or frightening nor will it be associated with food, rest, or toileting. We believe
that appropriate behavior is best taught through modeling and that inappropriate behavior can usually be
avoided through well-planned activities that sustain the interest and engagement of children. Discipline shall
consist of guidance in the form of helping children change undesirable behavior into more acceptable, satisfying
behavior. When disciplinary actions are necessary, we will use the following techniques:




Talking to the child to find out why they are displaying negative behavior.
Offering positive solutions to the problem causing the negative behavior.
If the negative behavior continues, the child will be redirected to a different activity or play group.
Parents will be notified of the negative behavior either verbally or in a written note or if the behavior is serious, the
parent will be called. On rare occasions, parents may be required to take their child home for the day.
CORPORAL PUNISHMENT IS NEVER APPROPRIATE AND NEVER USED.
Emergency Contact Information
The following person(s) may be called in the event of an emergency and have permission to pick my child
up from school.
(You must have at least 2 emergency contacts.)
Name:
Phone Number(s):
Relationship:
Name:
Phone Number(s):
Relationship:
In the event that I am unable to be reached and my child requires emergency medical attention, I authorize The
Preschool at Evening Rose to contact any of the contacts listed above. I also give the contacts listed above
authorization to pick up and remove my child from the preschool.
If The Preschool at Evening Rose is unable to reach either parent or the emergency contacts, I give my
permission to the school to consult my child’s physician and/or obtain emergency transportation services if
necessary.
Physician’s Name:
Phone Number:
Physician's Address:
Insurance Carrier:
Policy Number:
In the event that I, or my designated representatives are unavailable, I authorize The Preschool at Evening Rose representative to obtain
emergency assistance for my child. I agree to pay any medical expenses incurred for treatment and/or emergency transportation.
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Medical Needs, Allergies and Special Adaptations
Please list any known health issues including any previous serious illness, injury and/or allergies (including
food allergies, asthma, etc.). Also, list any special needs or accommodations that your child may need while in
the care and supervision of The Preschool at Evening Rose.
__________________________________________________________________________________________
__________________________________________________________________________________________
Previous child care / preschool experience
Please describe your child's previous child care and/or preschool experiences. Information should include type
of care, name of the child care provider/center and ages the child attended. This information will better help us
individualize care for your child.
__________________________________________________________________________________________
__________________________________________________________________________________________
Tuition Increases
I understand that because The Preschool at Evening Rose uses a month-to-month agreement rather than an
annual contract, tuition fees may be increased at any time with at least a two week notice. Tuition fees are
typically increased at the Children's Home Society's Fiscal Year (June/July). Parent’s Initials________
Open Door Policy
I understand that I have access to my child both in person and by phone during the normal business hours when
my child is in the care and supervision of The Preschool at Evening Rose. Parent’s Initials________
Holiday Celebrations
As part of our monthly curriculum, we use holiday celebrations to learn about different cultures as well as our
own. We take a multi-cultural approach to holidays, including Thanksgiving, Christmas, Hanukah, Kwanza and
Easter. Please use the space below to let us know what holidays your family celebrate so that we may include
it as a part of our holiday curriculum. Parent’s Initials________
__________________________________________________________________________________________
__________________________________________________________________________________________
Developmental Screening: I give permission for my child to be screened using the Ages and Stages
Questionnaire (ASQ) at least twice a year. I understand that I will have the opportunity to meet with my child's
teacher to discuss my child's development, possible referrals to community-based partners for further
assessment, transition to new classroom and more. Parent’s Initials________
Photo Release: I give permission for my child’s photograph or video image to be taken while he/she is in the
care of The Preschool at Evening Rose personnel. Such images may be posted in classrooms or other
appropriate places within the center, used in center presentations or promotional materials, or distributed to staff
or clients. I understand that I may terminate this permission in writing at any time in the future.
I Give Permission - Parent’s Initials________
I Do Not Give Permission - Parent’s Initials________
Authorization to Transport: In the event of an emergency that requires The Preschool at Evening Rose to
vacate the premises and I and/or my contacts are unreachable, I hereby authorize the Administrator, or the
person in charge in the event of his/her absence, to transport my child to a safe environment until I can be
reached. Parent’s Initials________
Acknowledgements required by The Department of Children & Families
The Department of Children & Families requires that all licensed preschools distribute information regarding
the discipline policy, "Know Your Child Care" and Influenza Flu prevention brochure. Please initial below to
acknowledge that you received this information.
Parent’s Initials________
Acknowledgement of Receipt - The Children's Home Society of Florida Consumer Handbook
This handbook contains information regarding CHS's mission, consumer rights and responsibilities,
confidentiality policy, consent for photos, grievance procedure and more. Please initial below to acknowledge
that you received this information and were given time to ask questions and understand the answers that were
given.
Parent’s Initials________
Page 4 of 5
Communicable Disease Policy
I understand that if my child is exhibiting symptoms associated with a communicable disease, or a fever of 100
degrees Fahrenheit (or higher) The Preschool at Evening Rose will remove/isolate my child and he/she may
not return without medical authorization or until the signs and symptoms are no longer present. For a
comprehensive version of the disease policy, please refer to the Parent Handbook. Parent’s Initials________
Supply Fees: There is a $75 supply fee per semester for the Fall and Spring semesters. The Fall semester fee
will be paid in August, and the Spring semester fee will be due in February.
Parent’s Initials________
Early Drop-Off / Late Pick-Up Fees: Children must be dropped off after and picked up by the required time
(see page 3 for your program choice and specific drop-off and pick-up times). Parents will be charged $5.00 for
every 15 minutes or part thereof for early drop-off and late-pick-up.
Parent’s Initials________
Return Check Policy: I understand that for any returned check, my account will be automatically billed a
returned check charge of $30.00. After two returned checks, I may be required to pay all fees with a credit card
or money order.
Parent’s Initials________
Withdrawal: I understand that a two-week notice in writing is required if I plan to withdraw my child from
The Preschool at Evening Rose. I understand that if I fail to provide a written two-week notice I am
responsible for the full-tuition daily rate equivalent to two weeks of care. Parent’s Initials________
APPLICATION FOR ENROLLMENT ATTESTATION/AGREEMENT
I attest that I am enrolling my child at The Preschool at Evening Rose, a program operated by the Children's Home Society
Early Learning Initiative, LLC. I have read and understand what is expected of The Preschool at Evening Rose and myself as
the Parent/Guardian. I understand that if any information contained in this enrollment form changes, I am to inform the
administration immediately. I understand that I am financially obligated for the full tuition each month regardless of my child's
attendance for that month and that The Preschool at Evening Rose will not prorate tuition based on my child's attendance,
holidays or scheduled or unscheduled school closings. Furthermore, I will adhere to the policies, schedules, tuition/fees and all
other information contained in this document and the Parent Handbook as set by The Preschool at Evening Rose.
Signature of Parent/Guardian
Date
Signature of Parent/Guardian
Date
Office Use Only
This application for Enrollment was received and reviewed:
Printed Name - Secretary
Printed Name - Program Director
Signature - Secretary
Signature - Program Director
Date
Date
~ Learn ~ Giggle ~ Grow ~
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