2023-2024 Preschool Registration Form

2023-2024 God's Window Preschool Registration

539 Buck Road, Holland PA 18966 215-364-3070 email: godswindow@comcast.net
2023-2024 God's Window Preschool Required Registration Form

You must complete this application by August 15, 2023 for your child to participate in the 2023-2024 school year. All information is required in order for your student to be registered and attend. One form per child, please.

You can download the Child Health form here. Please submit it completed by your child's physician by September 15, 2023. We can only receive shot records that have an electronic signature from your child's doctor AND the date of their most recent physical. If you are a returning parent and have a health form on file that is less than a year old and would like us to use that copy please contact the director. All medical forms must be updated annually. You can acess the health form here:

https://www.pct.edu/files/imported/campuslife/childcare/docs/ChildHealthAssessment.pdf

(Please mail the form or scan or email it to godswindow@comcast.net)

• Orientation Day is September 5th. The first days of school are September 6th & September 7th. Once this online registration form is submitted, a $50 Registration Fee is due to hold your child's spot. The Registration Fee is per family, and due every new year of registration.

• Tuition is due on the 15th of every month (10 even installments) beginning August 15th - May 15th.

• Families have the option to pay via check (the lockbox outside of the school office) or sign up online by visiting "https://www.northamptonpresby.com/preschool".

If mailing a check please send it to:

God's Window Christian Preschool

539 Buck Road

Holland, PA 18966

Telephone: 215-364-3070
Child's name:*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

malefemale
Admission Date*

September 6, 2023 (3 and 5 day students)September 7, 2023 (2 day students)Other
2023-2024 Enrollment

Please select ONE option for your child.
To be eligible for our Play Group, children must be 2 years 7 months by the start of school. Play Group chikdren need not be toilet taught.
Play Group (2-year-olds)
Child must be 2 years by February 6th to enroll in this class.
Nursery (3-year-olds)
Pre-K AM (4-year-olds)
Pre-K PM (4-year-olds)
Kindergarten Enrichment
ABC Camp (ages 3 & up)*
Preferred Payment Method*
Child Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent #1 Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address (or "same as child")

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent #2 Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Parent # 2 Address (or "same as child")

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contacts

Parents are the first emergency contacts. List the name of at least three additional people who can be contacted in the event of an emergency or illness if you cannot be reached. These individuals will also be approved pickup persons.. Any person listed should be able to assist in contacting you, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age with proper identification.
Emergency Contact #1*

First and last nameRelationship to Child
Phone Number*

Area CodePhone Number
Emergency Contact #2*

First and last nameRelationship to Child
Phone Number*

Area CodePhone Number
Emergency Contact #3*

First and last nameRelationship to child
Phone Number*

Area CodePhone Number
Name of Physician *
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician Phone Number*

Area CodePhone Number
Insurance Provider*
Insurance Policy #*
Does your child have any Special Disabilities?*

YesNo
Does your child have any allergies?*

YesNo
Does your child have a special health or medical condition?*

YesNo
If you answered yes to any of the questions above, please provide a brief summary of their condition.

First Aid and Emergency Medical Care Consent
Child's Name*

First NameLast Name
Today's Date

MonthDayYear
Date
My signature below authorize staff in the program, who are trained in the basics of first aid, to give my child first aid when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. I also understand that all incidents will be recorded using an incident report which will require the signature of the pick-up person. However, if I cannot be reached, I hereby authorize to transport my child to the nearest medical care facility and to secure necessary medical treatment for my child. I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in the program.
Full signature below to consent to first aid and emergency medical care for my child **

Clear
Please note any special accommodations for your child.
Is your child currently using any medication? If yes please explain. If no type "N/A'. **
I understand that it is my responsibility to provide an up-to-date health form for my child. This form must include my child's up-to-date vaccinations, the date of their last physical and a signature or e-signature from their doctor (link for the health form is available at the top of this document).*

Yes

Photograph/Media release authorization on behalf of God's Window Preschool
YES, I give permission to have my child appear in any media coverage (t.v., newspaper articles, photographs, website, GW private Facebook page and Northampton Presbyterian Church Facebook page) on behalf of God's Window Preschool.*

Yes
Walking Field Trips & Water Play Permission
YES, I give permission to allow my child to attend walking field trips and to participate in outdoor activities such as water day. I understand that it is my responsibility to send my child with all required items for special activities.*

Yes

Parent/Guardian Agreement
Please review the following policies and initial each.
General Policies and Financial Plan

I am enrolling my child in God's Window Christian Preschool for the 2023-2024 school year.
I understand that at the time of registration an application fee of $50 is due.
I understand there is a tuition installment due by August 15, 2023.
I understand that my child will not be dismissed from the program without being picked up by a parent-designated adult.
I understand there will be a $5 fee will be added every 15 minutes for any late pick-ups. I understand that chronic late pick-up may result in my child's unenrollment in the program.
I understand that if a medical emergency arises, program staff will attempt to contact parents or the emergency contact that I have indicated. (It is the parent’s responsibility to notify the staff if this information changes.) If immediate medical attention is necessary, an ambulance or emergency vehicle may take my child to the hospital of their choice.
In cases of illness, I understand that my child will not be permitted to attend the program. If staff feels that a child has a contagious disease, he/she may not return to the program without a doctor’s note.
In order for my child to be considered for this program I understand that I must complete all enrollment paperwork and health assessments.
I understand that God's Window Christian Preschool program is Christian faith-based.
I agree to update the emergency contact and parental agreement when changes occur or every 6 months at a minimum. (PA Code 3270.124, 3280124., 3290.124)

GOD’S WINDOW PRESCHOOL

FINANCIAL INFORMATION: Annual tuition is divided into 10 payments, due the 15th of each month from August 2023 through May 2024. Checks should be made out to God’s Window and deposited in the payment box located by the God’s Window Office or sent via US Mail. Cash payments should always be received personally by the GW Director. Online payment is an additional option (see below.) NOTE: PAYMENTS WILL NOT BE ACCEPTED VIA STUDENT BACKPACKS.

Late Fees: If tuition payment is not received by the 25th of the month a late fee of $25.00 will be assessed. An additional $25 dollar fee will be assessed for each month the balance remains unpaid. (For example: No tuition payment is made in January and a late fee is added to the account on Jan. 26. Then no payment is made in February. A second late fee is added to the account. If the account is not paid in full by Feb. 28, enrollment will be suspended effective March 1.) The payment date will be determined by the date the check was received. The check date is not used as a payment date.

Online/Automatic Payments:

Tuition payments may be made via ACH from a bank account using the Online Tuition Payment option found at www.northamptonpresby.com/preschool

We also offer the option of having recurring payments automatically withdrawn from a bank account via ACH. Please contact nptreas@gmail.com in order to take advantage of this option.

Outstanding Balances:

Any family that has not paid their child’s tuition plus any late fees for two months in a row will be contacted by the GW Director. At that time, the GW Director and the family will come up with a plan of action, either for immediate payment in full of past due amounts or an agreed upon payment plan for the full past due amounts which is created by the GW Director and documented in writing and signed by the parents.

*If no payment is made and/or the agreed upon payment plan is not met, the child will be excluded from the program until payments are made.
*If a pattern of late payment necessitates frequent reminders, the family may be required to pay in advance by the semester in order to be re-enrolled for the following year. No student(s) of parents owing overdue tuition/fees will be readmitted the following year unless the overdue amount is paid in full by June 30.

Tuition Refunds: Requests for prepaid tuition refunds must be made by the end of the month prior to withdrawal of the student. No refunds are available for partial month attendance. In the event of a school-wide closure due to COVID-19 restrictions, prepaid tuition will be refunded based on closure date. If an individual classroom is temporarily closed due to COVID-19 restrictions, no refunds will be issued.
I have read and understand the God's Window General Policies and Financial Plan (full signature)*

Clear

Nondiscrimination in Services
SUBJECT: Nondiscrimination in Services

TO: Parents/Guardians

FROM: Monica Platt

The provisions of services and referrals of clients shall be made without regard to race, color, religion, disability, ancestry, national origin (including limited English proficiency), age or gender. Program Services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of an aide. Structural modifications shall be considered only as a last resort among available methods. Any individual/client/patient/student (and/or their guardian) who believes they have been discriminated against, may file a complaint of discrimination with:

Northampton Presbyterian Church Christian Preschool 539 Buck Road Holland, PA 18966

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity Room 225 Health & Welfare Building P.O. Box 2675 Harrisburg, PA 17105

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity Southeast Regional Office 110 N. 8th Street, Suite 501 Philadelphia, PA 19107

PA Human Relations Commission Harrisburg Regional Office 333 Market Street, 8th Floor Harrisburg, PA 17101

U.S. Department of Health and Human Services Office for Civil Rights Suite 372, Public Ledger Building 150 South Independence Mall West Philadelphia, PA 19106-9111
I have read and understand the nondiscrimination in services notice (full signature) **

Clear
Dismissal, Discipline, and Discharge Policy

Children are not permitted to arrive alone and must be escorted by an adult. Children are only permitted to be signed out by an approved pickup over the age of 18.The fee for late pick up is $5 per 15 minute interval. Excessive lateness will be reviewed. Children are not permitted to bring any toys from home. A child who displays chronically disruptive behavior may be suspended or discharged at the discretion of the director. Examples of chronic, unacceptable behavior of the participant are: spitting, biting, or hitting, inflicting physical harm on other children or staff, inappropriate language or drawings, threatening harm, using profanities or obscenities, ridiculing or bullying, taking school or other children’s belongings, destruction of school or personal property, ignoring or disobeying the rules during the program times.
I have read and understand the Dismissal, Discipline, and Discharge Policy (full signature) **

Clear
Sign Document (Full Signature)*

Clear
Full Printed Name*
Date Signed*

MonthDayYear
Date

Health and Wellness Agreement
At God’s Window Preschool we are doing everything we can to keep our staff and children safe and healthy while in school.

We follow guidelines, requirements and recommendations of the CDC and the PA Department of Health. This Health and Wellness Agreement must be signed and on file for each child before the child starts school.

If the child or anyone in your household had any of the following symptoms of COVID-19 since the last time they were in school
- Shortness of breath or difficulty breathing
- Cough
- A fever or a sense of having a fever
- A sore throat
- Chills or repeated shaking with chills
- Headache
- Runny nose or congestion
- New loss of taste or smell
- Muscle or joint aches
- Rash
- Diarrhea
- Vomiting
- Has your child been in close contact with anyone suspected or confirmed with COVID-19?
- Has your child had any medication to reduce a fever, cough or congestion during the night or before coming to school?
If your child has any of the symptoms or you answer “yes” to the questions your child will not be admitted to the school, in accordance with our wellness policy. Please read the above policy, sign below.
Signature

Clear
Date

MonthDayYear
Date
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Should be Empty:

2023-2024 God's Window Preschool Registration

2023-2024 Enrollment

Emergency Contacts

First Aid and Emergency Medical Care Consent

Photograph/Media release authorization on behalf of God's Window Preschool

Walking Field Trips & Water Play Permission

Nondiscrimination in Services

Dismissal, Discipline, and Discharge Policy

Health and Wellness Agreement

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