2024-2025 Preschool Registration Form

2024-2025 God's Window Preschool Registration
2024-2025 God's Window Preschool Required Registration Form

You must complete this application (and have been in contact with our Preschool Director, Geri Broaddus) for your child to participate in the 2024-2025 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. 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.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/providers/documents/early-learning/certification/child-care-forms/CD%2051%20(formerly%20CY%2051)%20Child%20Health%20Assessment.pdf

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

• Orientation Day is September 3rd. The first days of school are September 4th & September 5th. 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

Geri Broaddus, Director

godswindow@comcast.net

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

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

malefemale
Admission Date*

September 4, 2024 (3 and 5 day students)September 5, 2024 (2 day students)Other
2024-2025 Enrollment
To be eligible for our Early Explorers, children must be 2 years 7 months by the start of school. Due to state regulations, we cannot accept 2 year olds born after February 4, 2022 for the 2024-25 school year.

Early Explorers children need not be toilet taught.
(FULL - Waitlist has started) Early Explorers (2-year-olds), previously called Play Group
(Recommended for children with birthdays between 9/1/21 - 2/4/22)
(FULL - Waitlist has started) Little Learners (3-year-olds), previously called Nursery
Pre-Kindergarten (4-year-olds)
Jr. Kindergarten (5-year-olds)
(Recommended for children with birthdays between 6/1/19 - 12/31/19)
Bible Buddies (add-on afternoon program for those attending Little Learners, Pre-K or Jr. K).
NOTE: You may only sign-up for ONE Bible Buddies class option. Hours are restricted, so you may choose a 5 Day class that runs until 2:30 PM, or a 3 or 2 Day class that runs until 3:30 PM.
Kindergarten Enrichment
Please let us know what elementary school you will be coming from in the field below.
KE Busing
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 pickups. 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 do 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 2024-2025 school year.
- I understand that at the time of registration a registration fee of $50 is due.
- I understand that the first tuition installment is due by August 15, 2024.
- 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:

MONTHLY TUITION PAYMENT:
The annual tuition is divided into 10 equal payments. Tuition is due on the fifteenth (15th) of the month, August 15th through May 15th. A $25 late fee will be assessed for payments received after the 25th of the month due. Tuition is non-refundable and must be paid for the child to participate in the program. For families enrolling three or more children, tuition for the third (youngest) child will be 50% of the above listed rate.

$50 REGISTRATION FEE (for new and returning families):
A non-refundable registration fee of $50 per family is due at the time of registration. If you refer a new family and they enroll in God’s Window your Registration Fee will be attributed to your first tuition installment. Please notify the Director of your referral. Registration for current families will be accepted when the current account is paid to date. Families enrolling for the 2023-24 school year after January 1, 2024 will pay a pro-rated Registration Fee of $25.

$90 ELP FEE:
The Experiential Learning Program (ELP) Fee is a one-time fee per child due before the first day of school, which covers the additional costs of “specials” such as Stretch ‘N Grow, Music Discovery, Farm Field Trip and monthly Pizza Days. Families enrolling for the 2023-24 school year after January 1, 2024 will pay a pro-rated ELP Fee of $45.

METHOD OF PAYMENT: (NOTE: PAYMENTS WILL NOT BE ACCEPTED VIA STUDENT BACKPACKS.)

ONLINE PAYMENT: "one-time" or reoccurring "monthly" payments are encouraged and can be set-up through the link on our website: www.northamptonpresby.com/preschool.

CHECK PAYMENT made out to “God’s Window” can be mailed to 539 Buck Road, Holland, PA 18966, or placed in the grey tuition box located outside of the preschool office. Description of payment should be noted on the bottom portion of the check. There is a $25.00 fee for all returned checks.

CASH PAYMENT must be handed directly to the Preschool Director or Church Office Administrator.

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: Geri Broaddus

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 your child, or anyone in your household, has ANY of the following symptoms, your child will not be permitted to attend school that day, in accordance with our wellness policy:
- 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
- Your child has been in close contact with anyone suspected or confirmed with COVID-19.
- Your child has taken medication to reduce a fever, cough or congestion during the night or before coming to school.
Please read the above policy and sign in acknowledgment below.
Signature

Clear
Date

MonthDayYear
Date
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Should be Empty:

2024-2025 God's Window Preschool Registration

2024-2025 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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