Return this form and $40 fee payable to Croton Church of Christ.  Monthly tuition is $85 each month.

Child's Name __________________________________________________________      M / F

Address  _______________________________________________________________________
                      Street                                                                                                               City/Zip

Mailing Address __________________________________________________________________

Age  ________        Birthday  ______________________       

Class preference        Pre-K  mark 1st & 2nd choice              _____  3 year old
                                 _____morning
                                 _____afternoon
                                                                                                                      

Phone Number  ___________________________        Church Affiliation   ___________________________

Mother's Name ____________________________        Father's Name _____________________________        

Mother's Cell ______________________________        Father's Cell  ______________________________
                           

The $40 fee is 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?  ______________________________________________________

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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?  ______________________________

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