Preschool - North River Christian Academy
Application For Admission Preschool Student 2015-2016 North River Christian Preschool North River Christian Preschool 1785McFarland McFarlandBlvd BlvdNN 1785 Tuscaloosa, AL 35406 Office Office 205.349.4881 Fax Fax 205.349.3246 Preschool Preschool 205.391.3601 northriverchristian.com A Message from Your Director Dear Parents, Thank you for considering North River Christian Preschool for your child’s care. It is our desire to assist you in providing the best Christian environment possible at an affordable price. As a ministry of Open Door Baptist Church, we exist to bring honor and glory to God. We believe that the greatest benefit to any child is to begin and develop a personal knowledge and relationship with Jesus Christ. Please look over what we offer and come talk with me to see if North River might be the right preschool for you. Some things we are offering for 2015-2016 are: • • • • • • Christ-centered instruction with caring staff Character training in an environment of loving discipline Cafeteria-style hot lunch program (for 3’s and 4’s) Tumblebus Gymnastic training Compuchild computer training I look forward to meeting you and getting to know your child in the coming days. In His Service, Alisha Hensel Alisha Hensel Preschool Director Michelle Stephens Michelle Stephens Assistant Preschool Director A ministry of Open Door Baptist Church APPLICATION FOR ADMISSION PRESCHOOL 2015-2016 For office use only Program applying for: Age level: ___________________________________ ͆͆ Full-day Registration fee: Ck # ________________________ Cash ________________________ ͆͆ Half-day Date Paid ____________________ ͆͆ 2 days _______ ͆͆ 3 days _______ Start date: _____________ Tuition rate: __________ ͆͆ School Office ͆͆ 4 days _______ ͆͆ Financial Office ͆͆ 5 days _______ North River Christian Preschool 1785 McFarland Blvd N Tuscaloosa, AL 35406 Office 205.349.4881 Fax 205.349.3246 Preschool 205.391.3601 northriverchristian.com Child’s full name __________________________________________________ Calling Tree Phone #__________________________ firstmiddlelast Girl _____ Boy _____ Age __________ Date of Birth _____/_____/______ Social Security Number __________________________ Address _____________________________________________________________________________________________________ streetcitystatezip Current age ______ Home phone (_____)__________________ Family’s church affiliation/denomination ______________________ Child residing with (check all that apply) ______ Mother ______ Father ______ Guardian ______ Stepmother _____ Stepfather Other ____________________________________________ Who has legal custody? ______________________________________ Parents are: _____ Married _____ Divorced _____ Separated _____Widowed _____ Other (explain) __________________________ FATHER Mr./Dr./Rev. ________________________________________________________________ Preferred Name ___________________ firstlast Address (if different) __________________________________________________________________________________________ streetcitystatezip Home Phone (_____)_________________________________________ Mobile Phone (_____)________________________ Employer __________________________________________________ Job Title ___________________________________ Work phone (_____)_________________________________________ E-mail address_______________________________ MOTHER Mrs./Ms./Dr. _______________________________________________________________ Preferred Name ___________________ firstlast Address (if different) __________________________________________________________________________________________ streetcitystatezip Home Phone (_____)_________________________________________ Mobile Phone (_____)________________________ Employer __________________________________________________ Job Title ___________________________________ Work phone (_____)_________________________________________ E-mail address_______________________________ List the name(s) of any previously attended preschools or daycares ______________________________________________________ FINANCIAL POLICIES TUITION/REGISTRATION North River Christian Preschool Registration The registration fee is a non-refundable annual payment. The preschool year begins August 13, 2015, and ends July 29, 2016. Preschool students must re-register each year. Registration is $100 for either the half-day program or the full-day program. Fees Activity fee - charged to parents who wish to have their child participate in gymnastics, the Tumblebus, and/or Compuchild. Book fee - a one time, non-refundable book fee that covers books and art supplies. The book fee is a rental fee. If a student withdraws from preschool they do not keep the books. Book Fee Supply Fee Toddler $15 (see list) K3 $50 $60 K2 K4 $35 $115 $60 $60 Supply fee - a one time, non-refundable supply fee. Tuition Tuition is paid monthly in one of the following ways (select one): ͆͆ Cash or Check - Tuition is due on the first of each month. A late fee of $25 will be added to accounts not paid by the 10th of the month. ͆͆ Credit Card - Tuition is charged to your credit card on the first of each month. A 5% service charge will be added to your bill each month for this convenience. Arrangements must be made through the financial office. Check the program you are applying for: Half-day Full-day Accounts not paid by the 10th of the month will result in the termination of services. Attendance Requirements The following classes are required to be enrolled for a minimum number of days each week: Infant-K2: 2 day minimum K3: 3 days minimum K4: 4 days minimum Extended Care Program 5 days $265 per month 3 days $220 per month 4 days 2 days 5 days 4 days 3 days Infants 2 days $245 per month $175 per month $510 per month $425 per month $340 per month $255 per month $40 more per month A 10% discount is offered for each additional child. Monthly tuition remains the same with no deductions made for absences or scheduled vacation days or holidays. Daily rate: $35 full day / $25 half day Monthly Tuition Rate____________________________ Full-day program preschool students receive free extended care which is included with their tuition from 6:30a.m. - 5:30p.m. Late pick-up fees are charged at the rate of $10 for each 10 minute increment past 5:30p.m. Half-day program preschool students may arrive anytime after 8:00am and must be picked up by 12:30pm. Late pick-up fees are charged at the rate of $10 for each 10 minute increment past 12:30p.m. PRINT CHILD’S NAME__________________________________________________________GRADE____________________ PERSON RESPONSIBLE FOR BILL___________________________________________________________________________ PARENT’S SIGNATURE__________________________________________________________DATE______________________ GENERAL INFORMATION North River Christian Preschool Lunches & Snacks Our hot lunch program is available to the 3’s and 4’s enrolled in our program for $4 per day. Lunch menus are available in the school office or on the website. All other preschool students must bring a lunch and drink each day. Every class will have a scheduled lunch time before 12:30pm. Please bring enough food according to the program your child is attending. Full-day: One lunch, drink, and two snacks Half-day: One lunch, drink, and one snack Bad Weather Classes will not be held during icy, snowy, or tornado conditions. We generally comply with the Tuscaloosa County School Board concerning closing the preschool due to bad weather conditions. The local ABC (33/40) affilliate will carry our announcements should we need to close. Also a calling tree message will be sent out from the school. Illness Please keep your child at home if they have any of these symptoms: • fever of 100.4 degrees or higher during the last 24 hours • discolored mucus from nose for 3 days or more • vomiting one or more times within the last 24 hours • diarrhea two or more times within the last 24 hours • symptoms of contagious infection (strep, pink eye, head lice and/or nits present on head, etc.) Forms needed when applying (personal checksheet): ͆͆ Application form ͆͆ Health Record form ͆͆ Preschool Pick up List form ͆͆ Emergency Card form ͆͆ Affidavit – may be notarized by Mrs. Lewis in the main office ͆͆ Birth Certificate – copy of the original ͆͆ Social Security Card – copy of the original ͆͆ Proof of Medical Insurance – copy of medical insurance card ͆͆ Certificate of Immunization – must be the original State of AL blue card Holidays and Program Dates July 3 Independence Day Aug 10-12 Teacher In-Service Aug 13 First day of preschool - fall Sept 7 Labor Day Oct 12 Columbus Day Nov 11 Veteran’s Day Nov 26-27 Thanksgiving Dec 24-25 Christmas Dec 31-Jan 1 New Years Jan 4 First day of school - spring Jan 18 MLK, Jr. Day Feb 15 President’s Day March 18 Spring Break March 25 Good Friday May 24 Preschool Graduation May 27 Teacher In-Service May 30 Memorial Day May 31 First day of preschool - summer PRESCHOOL PICK UP LIST 2015-2016 North River Christian Preschool Please list the names of all people you will allow to pick up your child from preschool. If someone comes to pick up your child and his/her name is not on the list, your child will not be released to that person until we have contacted you for permission. If you want someone to pick up your child and they are not on your pick up list, please call the preschool office. For safety reasons, if we do not recognize your voice on the phone, we will call your place of work and ask for your information. Until we get to know you, anyone that picks up your child may be asked to show a picture ID. Please be patient with anyone who does not know you and asks for identification. We are trying to ensure the safety and well-being of your child. CHILD’S NAME: ________________________________________________ AGE ____________________ Name Relationship Phone Number Alternate Phone Number parent (s) Please list anyone that MAY NOT pick up your child: _____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ HEALTH FORM 2015-2016 CHILD’S NAME_______________________________________ AGE __________ North River Christian Preschool PHYSICIAN/DENTIST: Physician’s Name Address Phone Number Dentist’s Name Address Phone Number MEDICATIONS: List all medications that your child regularly takes and give the reason for each. Medication DISEASES: Check any diseases that your child has had and give the date ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ Chicken pox ____________ Measles____________ Diphtheria ____________ Tuberculosis ____________ Rheumatic Fever ____________ Asthma____________ Scarlet Fever ____________ Whooping Cough ____________ Polio____________ Allergies ____________ Mononucleosis ____________ Mumps____________ Pneumonia ____________ Other (specify) ____________ OPERATIONS: Check any operations that your child has had and give the date ͆͆ ͆͆ ͆͆ ͆͆ Appendectomy ____________ Tonsillectomy ____________ Hernia____________ Other (specify) ____________ Dosage Reason(s) ALLERGIES: List all medications (or other substances) that your child is allergic to _________________________ _______________________________________________ PLAN OF ACTION IF EXPOSED: ________________ _______________________________________________ GENERAL HEALTH INFORMATION: Check any that apply to your child’s medical history ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ Frequent Colds Bronchitis Hearing Deficiency Heart Disease Convulsions Diabetes Frequent Sore Throat Abscessed Ears Stomach Upset Sinusitis Epilepsy Wear glasses Does your child have any physical limitations? Yes or No If yes, briefly explain___________________ PARENT’S SIGNATURE________________________________________________DATE______________________ GUARDIAN’S SIGNATURE_____________________________________________DATE______________________ AFFIDAVIT FOR PARENT/GUARDIAN North River Christian Preschool State of Alabama County of Tuscaloosa Before me, a Notary Public in and for said state and county appeared __________________________________ print parent/legal guardian’s full name and I known to me, after being duly sworn or affirmed, said as follows: The affivdavit is the parent or legal guardian of the child/children _______________________________ print child’s full name that affiant has been notified by Dan Habrial, a representative of North River Christian Academy and Open Door Baptist Church, and that said school or church has filed notice and is exempt under law from regulations by the Department of Human Resources. _____________________________________ parent/legal guardian signature Parent/legal guardian sworn or ascribed before me on this day ____/____/_____. ____________________________________ Notary Public signature My commission expires: _____/_____/_____ You may use NRCP’s notary public to sign this form at no charge. Please contact the school office for further information. Book List 2015-2016 North River Christian Preschool Books must be purchased during registration. The book fee is a rental fee. If the student withdraws from preschool they do not keep the books. Books will not be issued until the book fee is paid. STUDENT NAME(S): ___________________________________________________ GRADE: _________________ ____________________________________________________________________ ____________________________________________________________________ BOOK FEES: Toddler $15 ___________ $50 ___________ Kindergarten 2 $35 Kindergarten 4 $115 Kindergarten 3 Kindergarten 5 Elementary (1st-6th) Middle/High (7th-12th) $175 $225 $250 Total Due ___________ ___________ ___________ ___________ ___________ ___________ • Books issued in excellent condition must be returned in at least good condition. • Books issued in good condition must be returned in at least fair condition. • Books issued in fair condition must be returned. • Any non-consumable books not returned must be replaced at “new cost”. FINANCIAL OFFICE SIGNATURE______________________________________DATE______________________ PARENT’S SIGNATURE________________________________________________DATE______________________ Publicity, photo, achievement parent authorization 2015-2016 North River Christian Preschool North River Christian Preschool is hereby granted permission to use the names, pictures, words, and/or classwork for the student listed on this form for the purpose of yearbooks, awards/recognition assemblies, newspaper, television, web pages, social media sites, news releases, calendars, newsletters, etc. Without a permission signature, no publicity or recognition will be given. I understand that promotional pictures (individual and group) have been/will be taken during the school year. I give permission for my child’s photos to be used for any/all of the above purposes. ______________________________________________ ___________________ Student’s Name Grade __________ I give my permission for my child’s photos, etc. to be used. __________ I do not give permission for my child’s photos, etc. to be used. ______________________________________________ ___________________ Signature of parent/guardian Date PRESCHOOL EMERGENCY CARD 2015-2016 North River Christian Preschool Child’s Name_____________________________________________________ Birth Date_______/_______/_________ Address ___________________________________________________________________________________________ streetcitystatezip Phone #___________________________ Email address_____________________________________________________ To Parent or Guardian: To serve your child in case of an accident or sudden illness, please furnish the following: NameWork Phone #Cell Phone # Mother_____________________________________ __________________________ ____________________________ Father______________________________________ __________________________ ____________________________ List any known allergies or medical conditions_____________________________________________________________ List a neighbor, nearby relative, or friend who will assume temporary care of your child if you cannot be reached. Name & Relationship___________________________________________________ Phone #______________________ Permission for Emergency Treatment and Administering Medication I hereby give permission for the staff at North River Christian Preschool to call 911, if deemed necessary, in case of an emergency when I cannot be reached immediately. The attending physician also has my permission to give emergency medical treatment in my absence. I agree to assume responsibility for all medical costs incurred. I give my permission for the staff at North River Christian Preschool to administer the following medication to my child if deemed necessary (Check if Yes): ͆͆ ͆͆ ͆͆ ͆͆ ͆͆ Medicine prescribed by a doctor (that must be taken while the child is in the care of the school or preschool) Children’s Tylenol/acetaminophen or Children’s Advil/ibuprofen (for pain and /or fever with phone call to parent) First Aid Sunscreen Diaper Rash Cream No other medications will be administered except those listed above. If your child becomes ill, you will be notified. It is the parent’s responsibility to make sure the child’s emergency card is current. Father’s/Guardian’s SignatureDateMother’s/Guardian’s SignatureDate
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