CCDC REGISTRATION FORM: 2015-2016 School Year

For classes from September 2015 - May 2016

Christian Child Development Center - First United Methodist Church

907 W Main Street Lewisville, TX 75067

Telephone: 972-436-7233 Fax: 972-219-1877

Child’s Name: ______Birth Date: ______

Preferred Name: ______Please Circle: Boy or Girl

(name you wish your child to be called at school)

Parent(s): ______

Home Address: ______

City/State/Zip: ______Home Phone: ______

Email Address: ______

Class Hours: Monday through Friday 9am - 1pm.

Class Placement based upon age as of September 1.

Enrollment
Choice(s) / Classes / Days / Registration Returning Students / Registration
New Students / Registration After 5/31/13 / Supply Fee
(paid 2x yearly) / Monthly Tuition
Toddlers & Twos
18 months to start / Wed / $50 / $75 / $100 / $30 / $80
Toddlers & Twos
(age 2 by Sept 1) / T/Th / $50 / $75 / $100 / $60 / $160
Toddlers/Twos / T/W/Th / $50 / $75 / $100 / $90 / $195
PreK-3
(age 3 by Sept 1) / T/Th / $50 / $75 / $100 / $60 / $160
T/W/Th / $50 / $75 / $100 / $90 / $195
PreK-4*
(age 4 by Sept 1) / T/Th / $50 / $75 / $100 / $60 / $160
T/W/Th / $50 / $75 / $100 / $90 / $195
PreK-3/PreK-4*
Project Based Learning Class / Mon / $50** / $75** / $100** / $45 / $80
Fri / $50** / $75** / $100** / $45 / $80
PreK-5* / Mon-Fri / $100 / $100 / $100 / $125 / $290
Kindergarten*
(age 5 by Sept 1) / Mon-Fri / $100 / $100 / $100 / $125 / $290

**Registration fees are waived when enrolled in T/Th or T/W/Th class.

*Children MUST be able to use the restroom independently for all PreK-4, PreK-5 and Kindergarten classes.

For all classes except PreK-5 and Kindergarten:

The Registration and First Supply Fees are due at the time of registration. The Registration Fee is NON-REFUNDABLE and NON-TRANSFERABLE. The Supply Fee is only REFUNDABLE if your child is withdrawn from CCDC by May 31, 2015. The Supply Fee becomes NON-REFUNDABLE and NON-TRANSFERABLE after this date. Tuition is paid monthly from July 1, 2015 to March 1, 2016 and will only be refunded with a 30-day notice of withdrawal. The Second Supply fee is due on January 1, 2016.

For PreK-5 and Kindergarten Classes Only:

The Registration and First Supply Fees are due at the time of registration. Tuition and Second Supply Fee are due May 1, 2015. Tuition is then paid monthly until January 1, 2016. All Pre-K5 and Kindergarten payments are NON-REFUNDABLE and NON-TRANSFERABLE.

______Yes, our family would like information about church programs and Sunday School at FUMC.

Child’s Name: ______Birth Date: ______

Telephone Numbers Where Parents May Be Reached During School Hours

Mother: ______DL#______DLDLDL#______DL#______ / Father: ______DL#______
Business Name
Business Phone
Cell Phone

People (in addition to parents) for Emergency Contact and/or Authorized to Pick-up Child

Name: / Phone: / DL#: / Relationship / Emer Contact
Yes No / May Pick-up
Yes No
Address: / City: / Zip:
Name: / Phone: / DL#: / Relationship / Emer Contact
Yes No / May Pick-up
Yes No
Address: / City: / Zip:
Name: / Phone: / DL#: / Relationship / Emer Contact
Yes No / May Pick-up
Yes No
Address: / City: / Zip:

Child’s Physician

Name / Address / Phone Number

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the CCDC Director or person in charge to obtain emergency medical care for my child, including transportation, to the facility named here. I give consent for this facility to secure any and all necessary medical care for my child.

Please Circle: NEAREST AVAILABLE HOSPITAL or fill in the following information:

Name of Hospital / Address: / Phone Number

List any special conditions that your child may have, allergies, existing illnesses, previous serious illness, injuries during the last 12 months, any medication prescribed for long-term continuous use, and any other information which the CCDC staff should be aware of:

If no special conditions exist, please circle: N/A – Not Applicable

______

My child has been examined within the past year by a licensed physician and is physically able to participate in the CCDC program. I will obtain a physician’s statement, and submit it to CCDC. I hereby give my consent for my child to participate in properly supervised field trips or excursions in PreK-5 and Kindergarten classes; I understand that I will be notified in advance of each trip. All children will be seated in safety seat when being transported by private automobile. I will not hold liable any CCDC staff members, First United Methodist Church – Lewisville, or any parents chaperoning field trips for any sickness, injury or accident which may occur to my child.

I acknowledge receipt of the CCDC Parent Handbook and I agree to abide by all of the enrollment and operational policies it contains.

Photo Release: ___ I Understand that photos and/or videos will be taken during various school events (classroom activity, holiday events, field trips). I understand the photos/videos may be posted on bulletin boards, school website, facebook, and possibly youtube. We do not publish children names.

___ No- I do not give my permission to use my child’s photo/video for advertising for Christian Child Development Ctr.

______

Signature of Parent or Legal Guardian Date

Office Use: Enrollment Date: September 1, 2015 Class/Teacher: ______

Check #: ______Registration/Supply Fee: ______Tuition: ______