Preschool and Childcare Application

Campus*

School Term *

School Term: July to June

Schedule a Tour?*

YesNo

STUDENT INFORMATION

Child's Full Name*

First NameMiddle NameLast Name

Date of Birth:*

Date

Gender: *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Contact Phone:*

Please enter a valid phone number.

Resides Primarily With:*

If selected Others:

Write down the relationship with the child

PARENT 1 OR GUARDIAN'S INFORMATION

Financial and Enrollment Responsible Person

Please confirm this is the financial responsible person

Financial Responsible Person receives monthly invoice for tuition & fee.

Is this person responsible to complete the enrollment process?

Enrollment Responsible Person makes decision for enrolling and withdrawing the student. This person also need to complete the enrollment packet (last step of the enrollment process).

If not, who will complete the enrollment process?

Full Name:*

First NameLast Name

Relationship:*

Marital Status:*

Address: (if different than child's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Cell Phone:*

Please enter a valid phone number.

Work Phone:

Please enter a valid phone number.

Employer:

PARENT 2 OR GUARDIAN'S INFORMATION

Is this person share the financial responsibility?

Full Name

First NameLast Name

Relationship:

Marital Status:

Address: (If different than child's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email:

example@example.com

Cell Phone:

Please enter a valid phone number.

Work Phone:

Please enter a valid phone number.

Employer:

RCS SIBLINGS (K-12 oldest sibling is charged the first child rate. Any additional children will receive a discount

RCS Sibling's Full Name:

Campus:

Grade:

REFERRED BY

How Did You Hear About Us?*

Referring Family:

Programs

1. PRESCHOOL AND JR. KINDERGARTEN

School Term: September to May

School Time: 8:30a.m. to 11:00a.m.

2. PRESCHOOL AND JR. KINDERGARTEN with Childcare

Time: 7:00a.m. - 5:30p.m .(Max. 10 hours/day)

School Term (a): July - June (12 months includes summer)

School Term (b): September - June (10 months)

Please Select the Program*

1. Preschool and JR. Kindergarten2a. Preschool with Childcare - 12 months2b. Preschool with Childcare - 10 months

Age Group:

Days of Service Requesting:

If selected less than 5 days, which days do you need the service?

Maximum 18 characters allowed for this field.

Request to Start:*

The office will notify you with an approved start date.

Age Group:

Approx Drop Off Time:

Approx Pickup Time:

Days of Service Requesting:

If selected less than 5 days, which days do you need the service?

Maximum 18 characters allowed for this field.

Request to Start:*

The office will notify you with an approved start date.

It is the policy of RCS not to discriminate on the basis of race, color, national origin, sex, age, or disability in the admission and access to, or treatment or employment in its programs or activities. As a religious educational institution, RCS is permitted and reserves the right to prefer students, prospective students, employees and prospective employees on the basis of religion.

Preschool & Childcare Application