FAMILY DEVELOPMENT CENTER REGISTRATION

3-YR-OLD  AM  PM
(Must be 3 by Sept. 1)

 4-YR-OLD  AM  PM
(Must be 4 by Sept. 1)		 PRE-K  AM  PM
(Must be 5 by Nov. 1)
 
STUDENT NAME __________________________ NICKNAME________________________________________
ADDRESS __________________________ CITY_____________________ STATE______ ZIP_________
SUBDIVISION/PLAN __________________________ HOME PHONE_______________BIRTHDATE____________
FATHER'S NAME __________________________ MOTHER'S NAME__________________________________
OCCUPATION __________________________ OCCUPATION______________________________________
WORK PHONE __________________________ WORK PHONE_____________________________________
BROTHERS & SISTERS (NAMES AND AGES: ________________________________________________________________________________________________
SPECIAL PROBLEMS (MEDICAL CONDITIONS, ALLERGIES, EYES, EARS, SPEECH,
PHYSICAL/EMOTIONAL DISABILITIES):_______________________________________________________________
HAVE YOU HAD A CHILD GO THROUGH THIS PRESCHOOL BEFORE?    YES     NO
IF YES, WHEN? _______________________________
WHERE DID YOU HEAR ABOUT THIS PRESCHOOL?___________________________________________________
DO YOU HAVE ANY SPECIAL INTERESTS OR TALENTS YOU COULD SHARE WITH THE CLASS?
_________________________________________________________________________________________________
NAME OF RELATIVE/NEIGHBOR TO CONTACT IN PARENTS' ABSENCE:
___________________________________________________________________PHONE_______________________
IN CASE OF EMERGENCY, DO WE HAVE YOUR PERMISSION TO SEND YOUR CHILD TO NORTH HILLS PASSAVANT HOSPITAL?  YES     NO

PARENT'S SIGNATURE_____________________________________________________________________

REGISTRATION FEE IS $40 PLUS THE FIRST TUITION INSTALLMENT PAYMENT.
REGISTRATION MONEY MUST ACCOMPANY THIS FORM TO BE CONSIDERED REGISTERED.
THERE WILL BE NO REFUND OF THE REGISTRATION FEE OR FIRST INSTALLMENT PAYMENT.

ANNUAL TUITION FOR THE 3-YEAR-OLD PROGRAM (2 SESSIONS PER WEEK) IS $765.00.
(THIS IS MADE IN NINE INSTALLMENTS OF $85.00)

ANNUAL TUITION FOR THE 4-YEAR-OLD PROGRAM (3 SESSIONS PER WEEK) IS $990.00.
(THIS IS MADE IN NINE INSTALLMENTS OF $110.00)

ANNUAL TUITION FOR THE PRE-K PROGRAM (4 SESSIONS PER WEEK) IS $1215.00.
(THIS IS MADE IN NINE INSTALLMENTS OF $135.00)

TOTAL AMOUNT OF YOUR REGISTRATION PAYMENT: $_____________________

ALL MORNING SESSIONS ARE FROM 9 A.M. TO 11:30 A.M.
ALL AFTERNOON SESSIONS ARE FROM 12:30 PM TO 3:00 P.M.

RETURN THIS FORM WITH A CHECK MADE PAYABLE TO THE FAMILY DEVELOPMENT CENTER TO:
LINDA C. SMITH, 405 WOODCOCK DRIVE, CRANBERRY TWP., PA. 16066

STATE LAW REQUIRES ALL CHILDREN TO BE IMMUNIZED BEFORE STARTING SCHOOL.
PLEASE SEND A COPY OF YOUR CHILD'S IMMUNIZATION RECORD ALONG WITH YOUR
REGISTRATION FEE.

IF YOU HAVE ANY QUESTIONS, CALL LINDA SMITH AT (724) 935-6199.

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