Clover Presbyterian Preschool 2026-2027 Registration Form

Clover Presbyterian Church Preschool and Summer Camp Registration Form 2026-2027
- February 2nd- Registration for Current Students and Church Members
- February 16- Registration Opens to the community at 8am
- $150 Registration Fee for First Child
- $110 Registration Fee for Each Additional Child
Email for Important Registration Information *
example@example.com
Please select the option that best describes your child.*

My child is a current studentMy child is a current member of Clover Presbyterian Church.My child's sibling is a current student.My child is new to Clover Presbyterian Preschool.

Rows	First Choice	Second Choice
Four Day - Monday - Thursday - $405/Month
Five Day - Monday - Friday - $455/Month

Rows	First Choice	Second Choice
Four Day - Monday - Thursday - $405/Month
Five Day - Monday - Friday - $455/Month

Household Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1*

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Do you need to add another Parent/Guardian?*

YesNo
Parent/Guardian 2*

First NameLast Name
Parent/Guardian 2 Email*
example@example.com
Parent/Guardian 2 Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have siblings?*

YesNo
Names and ages of siblings living in the home. *

Authorization for Medical Information
I hereby grant permission for any staff person from Clover Presbyterian Church Preschool to take whatever steps may be necessary to obtain emergency medical treatment for my child. These steps include, but are not limited to the following:
1. Attempt to contact parent or guardian.
2. Attempt to contact the child's physician.
3. Attempt to contact the parent through any of the emergency contacts listed below.
4. If we cannot contact you, we will call an ambulance and have your child taken to the emergency room.
*

I agree and understand the above statement.
*

I understand that I am responsible for any resultant medical treatment expenses.
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone *
Format: (000) 000-0000.
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Phone *
Format: (000) 000-0000.
Emergency Contact 3*

First NameLast Name
Emergency Contact 3 Phone *
Format: (000) 000-0000.
Is your child covered by personal/family medical insurance?*

YesNo
Insurance Company and Policy Number*

Authorized Pick Up
If my child is to be picked up by anyone other than myself or spouse, I will notify the teacher in writing or in the case of emergency will call the preschool.

I understand that anyone listed below may pick up my child. These individuals must provide a picture ID.
*

If my child is to be picked up by anyone other than myself or spouse, I will notify the teacher in writing or in the case of emergency will call the preschool.
*

I understand that anyone listed below may pick up my child. These individuals must provide a picture ID.
Authorized Pick Up 1*

First NameLast Name
Authorized Pick Up 1 Phone *
Format: (000) 000-0000.
Authorized Pick Up 2*

First NameLast Name
Authorized Pick Up 2 Phone *
Format: (000) 000-0000.

Security Video Release and Acknowledgement

In order to promote the safety of children, staff and visitors, Clover Presbyterian Church Preschool has video surveillance cameras throughout the facility, excluding restrooms.
*

I acknowledge and have been notified of the video surveillance cameras

Photo Release

We love to take pictures at Clover Presbyterian Church Preschool. We use them to create bulletin boards, individual end of the year memory books, class projects, CPCP website, and to show the kids having fun, playing, and learning. We would like your permission to photograph/videotape your child for use in these projects. Photos will remain the property of CPCP unless otherwise noted.
Please check all that apply:*

I give my permission for photos to be taken for use in my child’s memory book, class or individual projects, and preschool displays within the church.I give my permission for photos to be added to the private CPCP FB Group.I give my permission for photos to be added to the preschool website.I give my permission for any photo/video to be taken by preschool staff and included in marketing materials such as website, advertisements, etc. for the discretional use for Clover Presbyterian Preschool.DO NOT USE MY CHILD'S PHOTO

Email Address and Phone Release
If another parent in the Clover Presbyterian Church Preschool program asks:*

My email address may be shared.My phone number may be shared.DO NOT SHARE MY INFORMATION

Monthly Tuition

Tuition is due the 15th of each month. First month's tuition is due June 15, 2026 and once paid, is non-refundable. Payments received after the 25th of each month will be subject to a $25 late fee. If tuition is not received by the last day of the month, your child will not be allowed to attend until tuition is paid.
*

I acknowledge that tuition is due the 15th of each month.
*

I acknowledge that the first month’s tuition is due June 15, 2026, and once paid, is non-refundable.
*

acknowledge that payments received after the 25th of each month will be subject to a $25 late fee.
*

I acknowledge that if tuition is not received by the last day of the month, my child will not be allowed to attend until tuition is paid.

Withdrawal Policy

If you choose to withdraw your child at any time during the school year, you must give a written 30 days notice to the director. There will be no refunded payments for mid-month withdrawals.
*

I understand that if I choose to withdraw my child at any time during the school year, I must give a written 30 days notice to the director. I understand there will be no refunded payments for mid-month withdrawals.

School Year Registration Fee:

The Clover Presbyterian Church Preschool School Year Registration Fee is Non-Refundable. $150 for the first child and $110 for each sibling. Once paid, your child has a secure spot for the 2026-2027 school year.
*

I acknowledge that my child's spot in the 2026-2027 Clover Presbyterian Church Preschool is not secure until I pay the non refundable registration fee.
Summer Program Registration Fee:

The Clover Presbyterian Church Preschool Summer Program Registration Fee is Non-Refundable. $50 for each child. Once paid, your child has a secure spot for the 2026 Summer Program.
*

I acknowledge that my child's spot in the 2026 Summer Program is not secure until I pay the non refundable registration fee.
***Once submitted your application will be accepted or waitlisted within 48 hours via email. If accepted, you will receive a payment link.
Should be Empty:

Rows	First Choice	Second Choice	Third Choice
Two Day (20 months +) - Tues/Thurs - $330/Month
Three Day - Mon/Wed/Fri - $405/Month
Five Day - Monday- Friday - $475/Month

Child Information