Preschool for 3 - 4 year olds
Sponsored by Cyrus Child Care Center
Children who currently are three or four years old are invited to join us on Tuesday, Thursday and Friday mornings for preschool. Our preschool program will include:
• social play
• story time
• gross and fine motor activities
• learning centers
• song and dance
• art activities
And much more!
Please fill out the attached registration form. If you have not attended preschool classes in Cyrus before please contact the District office at 795-2217 to arrange a visit with your child’s teacher.
Cyrus Child Care Center
Preschool Registration Form
2010-2011
Child’s Name: _______________________Child’s Age: __________ Birthday: _____________
Home Address: ____________________________ City___________ Zip
Code_________
Phone Number: _____________________
Father
Name:
_____________________________
Address (if different from child):
____________________________________________
Home Phone: __________________ Cell
Phone:_________________________
Email
Address:_______________________________________
Place of Employment:
_____________________________________________________
Working Hours: _______________ Business Phone:
____________________
Mother
Name:
______________________________
Address (if different from child):
____________________________________________
Home Phone: ________________ Cell
Phone:_________________________
Email
Address:______________________________________
Place of Employment:
_____________________________________________________
Working Hours: _______________ Business Phone:
____________________
Child’s Physician:
________________________________________________________
Address of Office: _________________________ Phone:
________________________
Child’s Dentist:
__________________________________________________________
Address of Office: _________________________ Phone: ________________________
Sources of medical and dental care to be used in an
emergency, if the child’s doctor and/or dentist are not available:
______________________________________________
Relatives or friends (who have already been notified by you)
who will assume responsibility for your child if you cannot be reached. (If one
or both biological parents may not pick up child/children, a court record must
be on file at the center. Please
attach court record, if necessary). These people may pick up my child also:
1. ___________________________________
Phone: ____________________Cell
Phone:_______________
Address:
________________________________________________________________
2. ___________________________________ Phone: __________________Cell
Phone:__________________
Address:
_______________________________________________________________
Rates
3 and 4 Year Old
Preschool
Yearly Trimester
Monthly (Sept-May)
3 Days a Week (T, TH,F) $810.00 $270.00/$270.00/$270.00 $90.00
2 Days a Week (T, TH) $540.00 $180.00/$180.00/$180.00 $60.00
1 Day a Week (T or TH) $270.00 $90.00/$90.00/$90.00 $30.00
Trimester payments due on September 14, December 9, and March 9.
Monthly Payments due by the 5th of the Month
Scholarships are available on a first come first serve basis. (*see
Other Important Information)
Lunch can be provided
from 11:30-12:15 at the child care center for an additional charge.
Enrollment Schedule
Weekly
Schedule: Special
Notes:
□ Tuesday _______________________________
□ Thursday _______________________________
□ Friday _______________________________
Required Paper Work:
To
be submitted as soon as possible
REGISTRATION PACKET
IMMUNIZATION FORMS: Each child must have an up-to-date
immunization record. The GREEN immunization form must be
complete, signed and on file prior to admission.
PHYSICAL EXAMINATION: Each child must have a current (within
one year) physical examination form (health summary) signed by the doctor and
on file within 30 days of admission
or the child will be excluded from the program. This PURPLE form may
be dropped off at the doctor’s office and faxed to us (320)795-2426.
CCAFP Household Income Food
Statement: This YELLOW form is necessary to determine
the center’s reimbursement from the food program and eligibility for a
scholarship (*See other important information).
In accordance with Federal law and U.S. Department of
Agriculture policy, this institution is prohibited from discriminating on the
basis of race, color, national origin, sex, age, or disability.
To file a complaint of discrimination, write USDA,
Director, Office of Civil rights, 1400 Independence Avenue, SW, Washington, DC
20250-9410 or call 1-800-795-3272 or
(202) 720-6382 (TYY). USDA
is an equal opportunity provider and employer.
Other important information:
Meals: The center participates in the Child Care Food
Assistance Program. Milk and snack will be provided. Lunch can also be provided
through the child care center for an additional fee.
Bills: Payments need to be made by the first session of each
month. If payment is not made,
your child is no longer enrolled in the program.
Program Times: The preschool program will run from 8:00 am to
11:30 am with optional lunch and recess until 12:15 for an additional
charge.
*Scholarships: Due to the limited amount of scholarship
dollars, up to 50% of tuition will be paid on a first come first serve
bases. Amount awarded will depend
upon your CCAFP Household Income Food Statement.
I am interested in a ______ One Day Scholarship ______Two Day Scholarship _____Three
Day Scholarship (Check one)
Permission Slip
- I
hereby grant permission for my child to use all of the play equipment and
participate in all the activities of the program.
- I
hereby grant permission for my child to leave the premises under the
supervision for neighborhood walks.
I understand I will need to sign a separate permission slip for any
other field trips.
- I
hereby grant permission for my child to be included in evaluations and
observations by teachers, local students, and student teachers. If my child is chosen for more
in-depth study or specific project, I will be informed about the exact
details and asked to sign another permission slip.
- I
hereby grant permission for my child to be used and possibly identified in
media publications such as newspaper, TV, radio, Web site, Brochures, etc.
when newsworthy events occur.
_________I
do not want my child to be photographed or video taken.
- I
hereby grant permission for the director and/or teacher to take whatever
steps may be necessary in an emergency situation. Someone trained in First Aid
and/or CPR may administer emergency treatment to my child until help can
be reached. If emergency
medical care is necessary, these steps may include, but are not limited to
the following:
- Attempt to contact a parent or guardian.
- Attempt to contact the child’s physician.
- Attempt to contact any of the other people listed.
- If we cannot contact you or the child’s physician,
we will do any or all of the following:
1.
Call another physician.
2.
Call an ambulance.
- Any expenses resulting from the above actions will
be the responsibility of
the child’s
family.
The center will not be
responsible for anything that may happen as the result of false information
given at the time of enrollment.
Child’s Name:
_____________________________________
Date: _______________________
Signature of Parent or Guardian:
_____________________________________________