Faithful
Friends
Christian
Academy
Rendering
a compassionate and enjoyable learning Environment
Kimberley
Dickerson, Founder & Director
Date of Application
___________
Preschool
Application
*Specifies
required information
STUDENT
INFORMATION
*Child’s
Last Name:_________________
*Child’s
First Name:__________________
*Date
of Birth:______________________
*Gender
(circle):
Male
Female
Sibling
Name(s) and Age(s):____________________
_______________________
____________________
_______________________
*With
whom does the child reside? (circle):
Mother
& Father Mother Father Other (please
indicate)__________________
*Special
needs or concerns:_______________________________________________
______________________________________________________________________
PARENT
OR GUARDIAN INFORMATION
*Father’s
Name:__________________________
*Phone
Number:_____________(H)
*Address:_______________________________
Phone Number:_____________(W)
E-mail:_________________________________
Cell Phone:________________
*Mother’s
Name:_________________________
*Phone
Number:_____________(H)
*Address:_______________________________
Phone Number:____________(W)
E-mail:_________________________________
Cell Phone:_______________
*Is
there a divorce or custody situation that we should be aware
of?________________
*If
yes, please
explain:____________________________________________________
How
did you hear about our
school?:________________________________________
PHYSICAL
DEVELOPMENT/HEALTH HISTORY:
*Please
indicate any allergies or specific medical
instructions:________________
______________________________________________________________________
______________________________________________________________________
*Is
your child receiving any professionally prescribed treatment?
Yes No
*If
so, please
explain:_____________________________________________________
______________________________________________________________________
______________________________________________________________________
*Shows
tendency toward (circle):
right hand left hand
*Language(s)
spoken in the home?__________________________________________
*Child’s
primary language:_________________________________________________
EMERGENCY
CONTACT INFORMATION
*List
any person to be contacted in the event of an emergency and none of
the parents are able to be reached:
Note:
Please only use local contacts for pick-ups.
*Name:____________________________
*Phone
Number:_____________________
*Name:____________________________
*Phone
Number:_____________________
*Physician:_________________________
*Phone
Number:____________________
CLASSES,
TUITION AND FEES
Classes
will be filled on a first come basis.
*Please
mark appropriate class time.
_____
Tuesday/Thursday (2 day Freshman Class)
Morning class: 9:00 – 11:30 a.m.
Age: 3 years old (must be 3 by January 1)
Cost: $650 ($130.00/Month)
_____
Monday, Wednesday, Friday (3 day Junior
Kindergarten)
Morning class: 9:30 a.m. – 12:00 p.m.
Age: 4 years old
Cost: $1280 ($160.00/Month)
_____ Monday – Friday (5 day Junior Kindergarten)
Morning Class: 9:15 – 11:45 a.m.
Age: 4 & 5 years old (must be planning to attend Kindergarten in 2020)
Cost: $2000 ($250.00/Month)
Monday – Thursday Lunch Bunch
(Please indicate if you are interested in this
program)
Time: 12
p.m. – 1 p.m.
Cost: $10
per day
Lunch
Bunch is an opportunity for children to enjoy play time, while having lunch
with friends. Preschoolers should bring
to school a NUT FREE packed lunch.
FINANCIAL
AGREEMENT AND REGISTRATION POLICY
FINANCIAL
AGREEMENT
We
hereby agree to pay tuition. We understand that tuition is based on
a full school calendar year and, for convenience, the tuition may be
made in nine equal monthly payments. We are aware that tuition
is due the first of the month, one
month in advance. (i.e.
payments for Oct. must be received by Sept. 1st.)
and payments
received after the 15th
of the
month will incur a $10.00 late fee. We realize that there are no
refunds or credits for temporary absences due to personal vacations,
illness and withdrawal.
REGISTRATION
POLICY
A
$50.00 non-refundable registration fee is required with this
application in order to secure placement for enrollment. A
NON-REFUNDABLE first
tuition payment is due no later than June 1, 2020.
ACTIVITY
AGREEMENT
I
acknowledge that as a student at Faithful Friends Christian Academy,
my child may be photographed and that the photos may be used on both
the FFCA website and Facebook page.
Additionally,
I understand,
weather permitting, my preschooler will regularly walk to the West
Lawn playground, as well as visit the West Lawn Library.
_________________________________________
_______________________
Parent/Guardian
Signature
Date
_________________________________________
_______________________
Parent/Guardian
Signature
Date
Faithful
Friends
Christian
Academy
15 Woodside Ave
West
Lawn, PA 19609
(484) 525-3501
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