Return this form and $40 fee ($30 registration fee & $10 supply fee) payable to Croton Church of Christ.
Monthly tuition is $85.
Child Name __________________________________________________________ M / F
Address _______________________________________________________________________
(Street) City/Zip
Age ________ Birthday ______________________ Class preference _____ 3 year old
_____ Pre-K
Phone Number ___________________ Church Affiliation ___________________________
Mother's Name __________________________________________________________________
Mother's Address ________________________________________________________________
(Street) City/Zip
Father's Name __________________________________________________________________
Father's Address _________________________________________________________________
(Street) City/Zip
The $40 fees are non-refundable.
___________________________________________ ________________
Parent's signature Date
Please fill in Child information on the back.
(BACK)
If your child prefers a nick name, what is it? _____________________________
Does your child have any comfort items? _______________________________
What are your child's favorite things to do? ______________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Does your child have difficulties with any of the following? (please write yes or no)
_____ walking _____ talking _____ eating _____ toileting _____ separation
If you answered "yes" above, please explain:
_________________________________________________________________________________________
_________________________________________________________________________________________
What are your child's favorite snacks? __________________________________________________________
_________________________________________________________________________________________
What are your child's food dislikes? ____________________________________________________________
_________________________________________________________________________________________
Is there any medical information or allergies? _____________________________________________________
_________________________________________________________________________________________
Is there any other information you would like us to know about your child? ______________________________
_________________________________________________________________________________________
SEE BELOW