Registration

3yr. old: AM_______  4 yr. old: AM________ PreK: AM_________
Student Name ________________________________________Gender M_____F___
Address__________________________________City______________Zip________
Home Phone__________________ Student Birth Date_________________________
Father's Name____________________________________________________________ 
Work #__________________________ Cell #___________________________________ 
Mother's Name ____________________________________________________________
Work #__________________________Cell#____________________________________
Primary Email Address_______________________________________________________
Secondary Email Address_____________________________________________________
Brothers & Sisters___________________________________________________________
Special Areas of Concern (medical, allergy, speech, etc.)
__________________________________________________________________________
How did you hear about our preschool? 
_________________________________________________________________________
Do you have any special interests/talents you could share with our kids
_________________________________________________________________________
PARENT SIGNATURE:________________________________________________________
REGISTRATION FEE IS $60.  ACTIVITY FEE IS $65.REGISTRATION FEE PLUS THE ACTIVITY 
FEE PLUS THE FIRST MONTH TUITION DUE AT REGISTRATION. THERE WILL BE NO REFUND 
OF THE REGISTRATION FEE OR FIRST INSTALLMENT PAYMENT.  THANK YOU.
ANNUAL TUITION FOR THE 3 YR. OLD PROGRAM (2 DAYS/WEEK) IS $1125.
*THIS IS MADE IN NINE INSTALLMENTS OF $125.
ANNUAL TUITION FOR THE 4 YR. OLD PROGRAM (3 DAYS/WEEK) IS $1440.
*THIS IS MADE IN NINE INSTALLMENTS OF $160.
ANNUAL TUITION FOR THE 5 YR. OLD PROGRAM (5 DAYS/WEEK) IS $2205.
*THIS IS MADE IN NINE INSTALLMENTS OF $245.
Total amount of your registration payment: $___________________
All morning sessions are from 9:00-11:30 am.  
Return this form with a check made payable to:
FAMILY DEVELOPMENT CENTER, 
670 PLEASANT HILL ROAD, WEXFORD, PA  15090
STATE LAW REQUIRES ALL CHILDREN TO BE IMMUNIZED BEFORE STARTING SCHOOL.  PLEASE SEND IN A COPY OF YOUR CHILD'S MOST RECENT IMMUNIZATION RECORD PRIOR TO THE FIRST DAY OF SCHOOL.

Printable version