NEW Student Application for 2023

NOTE: This registration form is for new students who are applying for Summer or Fall 2023.

Registration for current students can be found HERE.

Student Information

First Name *

Last Name *

Gender *

Birthdate * +

Street Address *

Address Line 2

City *

State *

Zip Code *

School Last Attended: *

Has your child been referred for special needs services (i.e. speech, behavioral, health, or developmental delays)? *

No

Yes (Please Explain) Yes (Please Explain)

Potty Trained?
Must be potty trained if 3 years old+. *

Yes

No

Pediatrician *

Pediatrician's Phone Number *

Does your child have any allergies? *

No

Yes (Please List) Yes (Please List)

Is your child taking any medications? *

No

Yes (Please List) Yes (Please List)

Registration Fees

Program Registration, Non-Refundable
Mark All That Apply *

Summer Registration, May 31 - August 11 ($135.00)

Fall Registration, Aug 21 - May 23, 2024 ($290.00)

Choose Your Campus *

Baseline (8am - 12 pm)

Route 66 (All Day Program)

SUMMER

ATTENTION: Summer registration is almost full. Please call the office, 626-963-8216, to check availability before making (and paying for) Summer selections.

Choose Your SUMMER Schedule *

5 Days (M - F)

3 Days (M, W, F)

2 Days (T, TH)

Choose Your SUMMER Plan *

Full Day (8:30 am - 3 pm)

Extended Day (6:30 am - 6:00 pm)

FALL

Choose Your FALL Schedule *

5 Days (M - F)

3 Days (M, W, F)

2 Days (T, TH)

Choose Your FALL Plan *

Full Day (8:30 am - 3 pm)

Extended Day (6:30 am - 6:00 pm)

Comments:

Current Total:

$0.00

Parent/Guardian Information

Guardian (1) First Name *

Guardian (1) Last Name *

Guardian (1) Relation to Student *

Guardian (1) Email Address *

Guardian (1) Mobile Number *

_____________________________________________________________________________

Guardian (2) First Name

Guardian (2) Last Name

Guardian (2) Relation to Student

Guardian (2) Email Address

Guardian (2) Mobile Number

Authorized Pickup (AP) Information

AP (1) First Name *

AP (1) Last Name *

AP (1) Relation to Student *

AP (1) Email Address *

AP (1) Mobile Number *

_____________________________________________________________________________

AP (2) First Name

AP (2) Last Name

AP (2) Relation to Student

AP (2) Email Address

AP (2) Mobile Number

Financial Agreement

Please view the Financial Rate Sheet and sign below.

New rates take effect on March 31, 2023.

>> FINANCIAL RATE SHEET <<

I have read and fully understand the Financial Agreement Contract of Foothill Christian Preschool and will abide by the terms of the agreement. I will be responsible to meet my financial obligation to the preschool.

I understand that the monthly payments are due the 1st of each month. A late fee is applied after the 5th of every month.

I understand there is a two-week notice when withdrawing or changing schedule for my child.

I also understand that the registration fees I pay today are non-refundable. *

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