CLHTF Enrollment Packet

Food Restrictions

Other than Allergies
Please List any Food Restrictions*
Food Restrictions will be honored due to religious or dietary reasons.In order to ensure the safety of our children with allergies, please complete an ALLERGYACTION PLAN if your child has a physician diagnosed allergy.We will post your child's picture with this specific information in the kitchen and classroom.
This form must be updated annually on your child's birthday to ensure the best practices at our school. Please sign below indicatingpermission to post Food Restriction information.*

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TUITION AND ENROLLMENT AGREEMENT
have read this Agreement, and I fully understand the contents of this Agreement. My signature below represents that I have the full authority to bind myself, spouse, child, and any other parent, stepparent, guardian agent, attorney, or representative of the child named below to the terms of this Agreement.*

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Appendix 4: Parent/Guardian Acknowledgment of Receipt
Printed Name of Parent or Guardian*
I have read and fully understand the policies and procedures set forthin the Children’s Lighthouse Parent Handbook. In addition, I havereceived a printed or electronic copy of the Handbook for my personalreference.*

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Automated Payment Processing

(we) hereby authorize Children's Lighthouse of Trinity Falls to initiate credit cardcharges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savingsaccount, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give10 days written notice. Credit union members: please contact your credit union to verify account and routing numbersfor automatic payments. Check with the center for accepted credit card types.
Complete one section only
Credit/Debit Card

If you would like to utalize a credit/debit card we do charge a 2% proccessing fee.
Cardholder Name:
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Credit/Debit Card Number
Expiration
Signature

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Bank Account (ACH)

Free Proccessing/No Fee
Account Holder Name:*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank or Credit Union Name*
Bank or Credit Union Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Routing Transit Number (See Sample below)*
Account Number (See Sample Below)*
Account Type*

CheckingSavings
Signature*

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All About My Child:

We would like to get to know your child better so that we cab tailor our lesson plans and activities to best meet the needs, temperaments, and personalilirs of the children that we have the honor to love and teach. Thank you for your time, we know it is precious.
During the week he/she lives with:*
During the weekend he/she lives with:*
Names and ages of siblings:*
Favorite things to do:*
Eating Habits:*
Food He/She Likes:*
Food He/She doesnt Like*
Please List the breakfast items your child eats on a regular basis:*
During the week sleeps usually happen from blanks* pm to blank.
When home usually naps from blanks* to blank* .
Average hours watches TV at home a week*
Favorite to watch*
Form completed by:*
Should be Empty:

Infant Enrollment Packet