ONLINE PRESCHOOL ENROLLMENT Class SelectionClass Options *Please select the class or classes you wish to enroll your child in.Toddler Class (M-F, 7:00 am-6:00 pm) -- $125 Registration Fee -- $180 weekly tuition2-Year Old Class (M-F, 7:00 am-6:00 pm) -- $125 Registration Fee -- $160 weekly tuition3-Year Old Class (M-F, 7:00 am-6:00 pm) -- $125 Registration Fee -- $145 weekly tuitionVPK-4 5-Day Class (M-F, 9:00 am-12:00 pm) -- $0 Registration Fee -- $0 weekly tuition Additional VPK Options (5-day) Would you like to add any of the following care options to your child's 5-day VPK enrollment?Morning Care (M-F, 7:30 am-8:45 am) -- $0 Registration Fee -- $25 weekly tuition or $5 dailyLunch Bunch (M-F, 12:00 pm-6:00 pm) -- $125 Registration Fee -- $125 weekly tuition Agreement *By selecting "Agree" and typing your name below, you agree to pay the required registration fee(s) for your child. Registration fees are non-refundable. Fees may be paid via our online Financial Transaction Center, by check, money order, cash, or by credit/debit card in the preschool office. You also agree that tuition pays for you child's enrollment space and is not based on your child's attendance. If you ever need to dis-enroll your child, you must provide two weeks written notice, and must have all fees paid before your child leaves the school.AgreeDisagree How do you plan to pay any applicable registration fees? *If enrolling for VPK-4 ONLY and/or Morning Care, please select "No Applicable Fee". If enrolling in Lunch Bunch, a $125 registration fee is required.Online Registration Fee PaymentIn-person with check, money order, or credit/debit cardNo Applicable Fee (VPK-4 or Morning Care ONLY) Next 1 / 6 Child InformationChild's Last Name: * Middle: * First: * Birthday * Sex *MaleFemale Home Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Home Phone * Secondary Phone Has your child been in childcare before? *YesNo Is your child toilet trained? *YesNo Is your child attending church or Sunday school? *YesNo If so, where? Are you or your child members of Prince of Peace Lutheran Church? *YesNo, but I am interested in receiving information about joining.No and not interested. Child's Physician * Physician's Phone * Does your child have any allergies or health concerns? *If none, please type "none" in the box below. Next 2 / 6 Parent InformationPlease select the option(s) that apply to your child and situation. *MotherFatherGuardian Mother's InformationName * First Last Birthday * Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Email * Home Phone * Mobile Phone * Place of Employment * Work Phone Father's InformationName * First Last Birthday * Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Email * Home Phone * Mobile Phone * Place of Employment * Work Phone Guardian InformationName * First Last Birthday * Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Email * Home Phone * Mobile Phone * Place of Employment * Work Phone Legal RequirementsA copy of the legal document verifying custody and visitation rights must be submitted if the parents are legally separated or divorced. *AgreeDisagree Section 65c-22.006(2) F.A.C requires a current physical examination and immunization record within 30 days of enrollment. (Blue & Yellow Form from Pediatrician) *AgreeDisagree Section 402.3125(5) F.S. requires that parents receive a copy of the “Know your child care facility” Brochure. *Download the brochure by clicking here.AgreeDisagree Section 65c-22.006(3)(c)2F.A.C requires that parents are notified in writing of the disciplinary practices used by the child care facility. *AgreeDisagree Next 3 / 6 Child ReleaseRelease Statement Your child will be released only to the custodial parent or legal guardian and the person(s) listen below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident, or emergency, if for some reason the custodial parent or legal guardian cannot be reached. Name Phone Secondary Phone Name Phone Secondary Phone Name Phone Secondary Phone Next 4 / 6 Permission StatementsPermission to Photograph & Videotape at Prince of Peace Preschool and CDCAgreement *Throughout the year, photographs & videos are taken of the children in action. These photos are periodically displayed to depict classroom happenings. Often these photos are given to the child’s family or placed in the child’s class journal. Occasionally photos are used in slide shows and may be used in Preschool advertisements. Video footage is taken at our school programs and events and then sold to preschool parents only.I give Prince of Peace Lutheran Preschool permission to photograph & video-tape my child and use the photos & video’s as stated above.I DO NOT give Prince of Peace Lutheran Preschool permission to photograph my child and use the photos as stated above. Permission to Ride Tricycles at Prince of Peace Preschool and CDCAgreement *I give my child (as indicated previously in this form) permission to ride on the tricycles during outdoor time at Prince of Peace Preschool and CDC. Regardless of selection, you agree that you will not hold Prince of Peace Preschool and CDC liable for any accidents or incidents that may occur with the use of the tricycles.My child must wear a helmet when riding the tricycle. (Helmets must be provided from home each day and will remain in your child's bag)My child is allowed to ride the tricycles without a helmet.I do not wish to have my child ride the tricycles. Next 5 / 6 Final AgreementParent/Guardian Name By typing your name in this box, you verify that all of the above information is accurate. You also verify that you have completely and accurately filled in all required boxes and fields. You will be asked to enter a two-digit verification number in the next section. This is simply to minimize the amount of spam often received through online forms such as this. Please enter any two digits, then click Submit. You should receive a confirmation email once you have submitted this form. If you do not receive a confirmation, you may contact the preschool office to verify receipt. Confirmation Email *Please enter a valid email address that you would like to receive a confirmation email at. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank 6 / 6
