PDO 23/24 ENROLLMENT

Parent's Day Out

2023-2024 Enrollment/Re-Enrollment Form
Please fill out this enrollment form completely. Accurate information is necessary so that we may place your child in the appropriate class and contact you with information regarding the upcoming school year. It is your responsibility to notify us immediately of any changes.
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age as of September 1, 2023*
Father's Name*

First NameLast Name
Occupation*
Father's Work Phone*
Please enter a valid phone number.
Father's Cell Phone*
Please enter a valid phone number.
Mother's Name*

First NameLast Name
Occupation*
Mother's Work Phone*
Please enter a valid phone number.
Mother's Cell Phone*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Father's Email*
example@example.com
Mother's Email*
example@example.com
does your chld suffer from any medical, physical, emotional, or behavioral condition, which might effect his/her safety or ability to participate in activities?*

YesNo
If "Yes," please explain
(Individual consideration shall be given for each request for enrollment of a special needs child. Acceptance of the child is to be considered a trial until it is fully established that the needs of the child can be met without loss to the whole group)
Is your child potty trained?*

YesNo
How did you hear about us?*
Has your child attended school or been cared for by any other person besides your immediate family? Please explain.*
Authorization for Emergency Medical Attention:

In the event that I cannot be reached to make decisions about emergency medical attention, I authorize the Parent's Day Out Director and/or Trinity Baptist Church staff to obtain emergency medical treatment for my child.
Parent/Guardian Signature*

Clear
Does your child have any allergies (food, insects, plants, medications)?*

YesNo
Special Instructions
Child's Physician*
Physician Phone*
Please enter a valid phone number.
In the event of an accident or sudden illness to my child, I hereby authorize a school representative to refer to the physician above if I cannot be reached by phone.*

YesNo
Preferred Hospital*
Hospital Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hospital Phone*
Please enter a valid phone number.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
A copy of your child's current shot record is required for admission to our program.
Photo Release

I understand that photographs and videos may be taken of my minor's participation in various activities while participtating in various activities while participating in the Children's Ministry of Trinity Baptist Church, including Parent's Day Out. I understand these images and videos may be used in promotional materials, publications, and social media accounts associated with Trinity Baptist Church. I acknowledge below that I consent to my minor's likeness beign shared and do not request compensation for the use of my minor's likeness.
Parent/Guardian Signature*

Clear
Or

I do NOT consent to my minor child's images being used.
Parent/Guaridan Signature*

Clear
Registration

I understand that there is a registration fee of $150 due when I enroll. Should I choose to withdraw my child from the program or change my mind about enrolling my child after the registration fee is paid, I understand that my registration fee will not be returned to me without exception.

Tuition

Tuition is $250 per month and due on the first school day of each month. Half of September's monthly tuition ($125.00) is due on or before 12:00 pm July 14, 2023, and is non-refundable, without exception. Failure to pay the tuition within the first school week of each month may result in removing your child from their class in order to accommodate another child who is on our waiting list.

Late Pick Up Fee

Parent's Day Out ends at 2:00 pm. There will be no late charge if your child is picked up from 2:00-2:15 pm. From 2:15 until 2:20 pm, there will be a $15.00 charge for late pick up. There will be a $1.00 per minute charge for every minute after 2:20 pm.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Emergency Information Sheet
Person/Persons to call in case of emergency OR if parents cannot be reached:
Name/Relation*
Phone Number*
Please enter a valid phone number.
Name/Relation
Phone Number
Please enter a valid phone number.
I hereby authorize the Parent's Day Out teachers, staff, and Director to allow my child to leave the facility ONLY with the following persons:
Name/Relation*
Name/Relation
Name/Relation
Name/Relation
You may update you authorized pickup list anytime. Please contact PDO Director to add or remove people from your list.
Should be Empty:

Parent's Day Out

Authorization for Emergency Medical Attention:

Emergency Information Sheet