COMO PARK LANGUAGE AND ARTS PRESCHOOL AND CHILDCARE CENTER
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Registration Form

COMO PARK LANGUAGE AND ARTS

 PRESCHOOL AND CHILDCARE CENTER

1503 Hamline Avenue, Saint Paul, Minnesota 55108
Phone:  651-646-0310       Fax:  651-756-1185
    cplapcc@gmail.com

REGISTRATION FORM

*Please return this form with the $150.00 non-refundable registration fee to ensure a spot

Check the option you would like to enroll for. 

FULL DAY   5 DAY PROGRAM (MONDAY THROUGH FRIDAY)           
7:30 a.m.-5:30 p.m.

FULL DAY    4 DAY PROGRAM (CHOOSE ANY 4 DAYS IF AVAILABLE)
7:30 a.m.-5:30 p.m.

FULL DAY    3 DAY PROGRAM (CHOOSE ANY 3 DAYS IF AVAILABLE) 
7:30 a.m.-5:30 p.m.


Check all of the days/week that you are requesting     __Monday     __Tuesday   __Wednesday  __Thursday  __Friday

 

FEE SCHEDULE

FULL TIME           5 DAY PROGRAM                        $265/WEEK

FULL TIME           4 DAY PROGRAM                        $243/WEEK

FULL TIME           3 DAY PROGRAM                        $207/WEEK   

 

STUDENT INFORMATION

Student Name:______________________________    Nickname:__________________________________

Student Address:____________________________    Gender:____________________________________

____________________________Zip____________     Birthday:___________________________________

Student’s Telephone_________________________                                        (Month, Day, Year)

 

PARENT/GUARDIAN INFORMATION

Parent/Guardian:______________________________Parent/Guardian ____________________________ 

Employer:____________________________________Employer:__________________________________

Work Phone__________________________________Work Phone________________________________

Home Phone__________________________________Home Phone_______________________________

Cell Phone____________________________________Cell Phone_________________________________

E-mail address_________________________________E-mail address______________________________

 

MEDICAL INFORMATION                                                 
Allergies:__________________________________

Child’s Physician:___________________________     Child’s Dentist:_______________________________

Address:__________________________________      Address:____________________________________

Telephone:________________________________     Telephone:_________________________________

 

 

EMERGENCY INFORMATION

1st Contact Name:__________________________    2nd Contact Name:____________________________

Relationship to child:_______________________    Relationship to child:_________________________

Address:__________________________________    Address:____________________________________

Telephone and Cell:________________________    Telephone and Cell:_________________________

 

FAMILY INFORMATION

Home Language spoken:______________________ Does child speak English?___________________

Please list all adults and children living at home and their relationship to the child.  Please include children’s ages:___________________________________________________________

_____________________________________________________________________________________.

 

HOME ENVIRONMENT INFORMATION

Is child bladder trained?______________________ Is child bowel trained?_____________________

Child’s preferred hand:_______________________ List any physical conditions:__________________

Does your child have expressions, habits, or problems we should know about? ________________

What behavior do you find most difficult to deal with? ______________________________________

Please list your child’s fears, their history and how they show their fear?______________________

How does your child interact with other children?___________________________________________

Classroom or childcare experience?_________________________Neighborhood playmates?______

Does your child have learning or social difficulties?___________________________________
What do you hope your child will gain from attending our program?___________________________

____________________________________________________________________________________.

 

         I am open to screen time for my child (meaning occasional movie days and computer opportunities).

         I prefer NO screen time for my child.

 

PROGRAM REQUIREMENTS    With my signature below:

*I request entry into the Como Park Language and Arts Preschool and Childcare Center.  I understand that the $150 registration fee is NON-REFUNDABLE and will NOT be returned to me for any reason.  A one month written notice is required should I leave the program before May 31st, 2019.  I will be held responsible for that amount of tuition should I leave without notice.

 

*I give permission to the Como Park Language and Arts Preschool and Childcare Center to include my child’s name, address, and phone number on a roster.  I give permission for my child’s pictures to be posted on an INTERNAL website, only available to current families.  All other shared information is intended for confidential use of our program. 

 

Signature:_________________________________________Date:____________________________

 

 

For marketing purposes, how did you hear about our program?______________________________

 

*Following entrance into our program, additional paper work and information will be sent.  Our program is licensed by the State of Minnesota Department of Health Services.

      

Como Park Language and Arts Preschool and Childcare Center provides a safe, loving environment for children. We accept children from 33 months to five years of age. We play developmentally appropriate games, teach ABCs and 123s, and supply nutritious snacks. We are open from 7:30am to 5:30pm. Each child receives loving care and attention at Como Park Language and Arts Preschool and Childcare Center. Your child will love our large collection of toys and games. We even have a large fenced in yard to run and play in. We are close to the local recreation center that has a fun playground area. 

 

Nurturing & Stimulating Environment!

ABCs & 123s, Language and Vocabulary development, and fun Art Activities!


 

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