Second Form: Enrollment Application 2019-2020

2025-2026 Student Enrollment Forms
Please Review and Fill out the following forms for enrollment at Superior Start Christian Learning Center. The Director will review this form with you during your child's intake meeting.

Please note: your form will not be complete until you have clicked the "Submit" button on the last page.

Please feel free to contact us if you have any questions!

856-423-2529 or superiorstartclc@gmail.com
Thank you!
Child Profile
You are the person who knows your child best! You are with your child on a daily basis, observing and interacting with them and you are uniquely qualified to give us insight into your child's development. Please take a minute to complete this profile so we can get to know your child better and determine how best to give them the Superior Start they deserve!
Child's Name

First NameLast Name
Date of Birth
Age
Gender
Name your child prefers to be called
Child's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
What are your top 3 goals for your child in their time with us?
What is/are the primary language(s) spoken in your home?
What avenue(s) of play most interests your child? (Dramatic, building, sensory, etc.)
What words does your child use for toileting?
How would you describe your child's personality?
What activities does your child enjoy the most?
Please describe your child's mealtime routines at home.
YesNo
For how long?
What family or cultural traditions are important in your home?
YesNo
Parent Contact and Release Persons
Parent/Guardian 1

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email
example@example.com
Occupation
Employer
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone

Area CodePhone Number
Which number should we call first if we need to reach you during your child's school day?*
YesOther
Driver's License #/ State (This information will be used to verify your identity should you need to call to make changes to your child's normal pickup routine)
Parent/Guardian 2

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email
example@example.com
Occupation
Employer
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone

Area CodePhone Number
Which number should we call first if we need to reach you during your child's school day?*
YesOther
Married/togetherSeparatedDivorcedOther
Driver's License #/ State (This information will be used to verify your identity should you need to call to make changes to your child's normal pickup routine)
Emergency Contact and Release Persons

Please list the individuals you would like us to contact (in order of priority) if you cannot be reached in case of emergency. Check the "Emergency Contact and Release" box for individuals who are authorized to pick up or accompany your child for the purposes of medical treatment.

We will not release a child to anyone (other than a parent/legal guardian) under the age of 18, including siblings.

Additionally please list the individuals you would like to be authorized for pick-up only. For these individuals check the "Release Only" box. For the safety of your child, we will request all authorized release individuals to provide a government-issued photo id at the time of pick up.
First name*
Last name*
Relationship to Child*
Cell Phone*
Home Phone*
Work Phone*
Emergency Contact and ReleaseRelease Only
Last name*
First name*
Relationship to Child*
Cell Phone*
Home Phone*
Work Phone*
Emergency Contact and ReleaseRelease Only
First name
Last name
Relationship to Child
Cell Phone
Home Phone
Work Phone
For the safety of all children and staff, it is vital to use your secrued access to enter the building and sign your child in and/or out in accordance with state child care licensing regulations. To maintain a safe and secure environment please do not share your secured access with anyone. Please review our Policy on the Release of Children located in our Student Handbook.
Please note: If an individual who is not authorized above will be picking up your child, you must notifiy the staff in advance, via a BrightWheel message. Your child will not be released without prior authorization. In the event that you call in to authorize a pick-up because you are unable to submit the authorization in writing, we will use your Driver's license ID number to verify your identity.
Emergency Contact and ReleaseRelease Only
Health & Medical History
My child is in good health and can participate in the normal activities of the program and has no known conditions or special needs that require special accommodations.My child can participate in the normal activities of the program but has conditions or special needs that require special accommodations as indicated below.
Please list any allergies, medical conditions, including chronic health problems (such as asthma, seizures, etc.), behavioral disorders, special needs, etc.
Does your child have any special medical, physical, speech or cognative needs? Explain:
All students must return the Universal Child Health Record form signed and dated by their Health Care Provider as well as a copy of their up-to-date immunizations prior to the start of the school year (or student start date) as per state licensing requirements. Students requiring a medical action plan for allergies or other medical conditions are asked to bring a copy to keep on file.
Tuition Agreement 2025-2026
The financial stability of an independent school is essential to its overall success. We must commit ourselves to staff salaries, materials, insurance, etc. on an annual basis based on enrollment. Therefore, the absence or withdrawal of a student does not reduce operating expenses. These realities require us to ask for an annual commitment from our families.

Superior Start Christian Learning Center agrees to admit the child to the programs agreed upon after review and acceptance of a completed Application Form. The Parent/Guardian agrees to pay the tuition and fees in accordance with the terms and conditions of the 2025-2026 Tuition Schedule and 2025-2026 Tuition Policy.

These policies are outlined in our Student Handbook.
Tuition Policy

Tuition payments are payable in advance and due in full on the first of the month. If the first falls on a weekend, payment is due by the following Monday.

Tuition can be paid via check, money order or credit card. There will be a $35 return check fee for any personal check that is returned due to insufficient funds.

A $35 late payment fee will be charged to your account if tuition is not paid by the 5th of the month.

If tuition charges are past due after 7 days, your child will not be allowed to attend until payment is made in full. Failure to make payment after this point will result in the loss of your child’s enrollment position.

Absences due to illness or vacation do not reduce the cost of monthly tuition or allow for make-up days. Should there be an extended illness adjustments can be made on a case-by-case basis (up to a maximum of 5 days per school year) with proper documentation from your child's pediatrician.
I agree
Accept
I agree
Accept
If you would like your invoices to be sent to anyone else other than parents/guardians, please give the following information:
Invoice Recipient's First Name:
Invoice Recipient's Last Name
Phone Number
Mailing Address
Zip code
State
Invoice Recipient's E-mail
example@example.com
Agree and Submit
I apply for the enrollment of my child at Superior Start Christian Learning Center

Required fees to complete enrollment are:

Application Fee: $35.00

New student Enrollment deposit: 1 Week of Tuition

You will receive a registration invoice (application fee + enrollment deposit) after your child's application has been reviewed and classroom availability has been confirmed.

Registration and/or Deposit must be received to complete enrollment!*

*Please be sure to pay the tuition deposit before your Intake Meeting date to insure your child's spot is secured for the 2025-2026 School Year.
By digitally signing below you are acknowledging that you have filled out this form and agree to any and all aforementioned financial and educational policies of Superior Start Christian Learning Center.
Parent/Guardian Signature

Clear
Today's Date*

MonthDayYear
Date
Enter the message as it's shown*

2025-2026 Student Enrollment Forms

Parent Contact and Release Persons

Health & Medical History