121 Manor Avenue
Downingtown, Pa. 19335
(610) 873-1113
(Please Choose One)
2 Year Old Play Group T- Th_____ Pre-School M-W-F a.m._____ Pre-K M-W-F a.m._______
Young 3's T-Th a.m._____ Pre-School T-Th a.m. _____ Pre-K M-W-F p.m._______
Pre-School T-Th p.m. _____ Pre-K 5 Day a.m. _______
Parents Names:_____________________________________________ Phone:_________________
Address:__________________________________________________________________________
Child's Nickname:___________________________________________ Date of Birth: ___________
School district in which you reside:_____________________________________________________
Mother's Work Place and Phone Number:________________________________________________
Father's Work Place and Phone Number:_________________________________________________
We will make every attempt to reach the parents first.
Emergency Contact and Phone Number:__________________________________________________
(We need a local number other thaen parents work place.)
Emergency Contact and Phone Number:__________________________________________________
(We need a local number other then parents wor place.)
Please list any special fears, interests, or unusual circumstances which you feel we should be aware of, i.e. death in family, divorce, adoption, etc._________________________________________________
___________________________________________________________________________________
Has your child had any pre-school or day-care experience?____________________________________
Name of Previous School:______________________________________________________________
Name any Allergies or Special Medical Needs your child has:___________________________________
____________________________________________________________________________________
The reason I selected this Pre-School:_____________________________________________________
What I hope my child will gain from this experience:_________________________________________
A $50 non-refundable registration fee must accampany this application. Tuition is due the 10th of the preceding month with a ten day grace period. Tuition is not refundable after the child has started the month. Checks returned to us will have a $25 service fee.
Mother's Signature:___________________________________ Date:_____/_______/______
Father's Signature:____________________________________ Date:____/_______/_______
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For Office use only: Date:_____/_______/_________ Check#:____________ Amount:$__________