Preschool Application

By filling out this form in completion, you are agreeing to the following:

We are not physically equipped to satisfactorily handle pupils who do not respond or adjust to the daily routine in preschool, who demand too much individual attention, or who definitely show emotional disturbance. If after consultation with the parents we find that the child has not improved, we reserve the right to ask for withdrawal of the child.
The monthly payment of $130.00 is due and payable on the first preschool day of the month, After the 3rd preschool day of the month you will be assessed a late fee of $25.00. Checks are made payable to Pleasant Days Preschool.
If in the event Pennsylvania increases it's minimum wage, tuition rates may be impacted to maintain preschool operations

Note

Transportation will be provided by parents.
Please send $25.00 non refundable enrollment/supply fee.

About Your Child

Child's Name

First Name

Last Name

Gender

Male

Female

What name should the teacher use in addressing your child?

Name/Nickname you want your child to learn to write

Year your child plans to enter kindergarten

About You

Mother/Guardian's name(s)

First Name

Last Name

Father/Guardian's name(s)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Information

Preferred Phone Number

(###)

###

####

Emergency Contact Information

Which parent should be contacted first?

During preschool hours

Father's Cell Phone

(###)

###

####

Father's Employer and Work Number

Father's Occupation and Position

Mother's Cell Phone

(###)

###

####

Mother's Employer and Work Number

Mother's Occupation and Position

Relatives or Friends in Case of Emergency

In addition, those listed ARE AUTHORIZED BY YOU TO PICK UP YOUR CHILD FROM PRESCHOOL. List at least two. Please list the relationship to your child (i.e. grandmother, friend, neighbor, etc.)

Other Information

Is your child potty trained?

Photo Release Opt-Out

If you DO NOT want your child's picture to appear in local publications, Facebook, or website, please initial here.

Agreement and Time Selection

Agreement

We are not physically equipped to satisfactorily handle pupils who do not respond or adjust to the daily routine in preschool, who demand too much individual attention, or who definitely show emotional disturbance. If after consultation with the parents we find that the child has not improved, we reserve the right to ask for withdrawal of the child. The monthly payment of $125.00 is due and payable on the first preschool day of the month, After the 3rd preschool day of the month you will be assessed a late fee of $10.00. Checks are made payable to Pleasant Days Preschool. If in the event Pennsylvania increases it's minimum wage, tuition rates may be impacted to maintain preschool operations.