HeartPrints Centerfor Early Education

Regional Learning Alliance

850 Cranberry Woods Drive   Suite 1227              

Cranberry Township, PA   16066              

724.741.1008

               

Preschool Registration Form  2009-2010

               

CHILD’S NAME  ______________________________  BIRTHDATE ____/ ____/ ____

                                Last                           First

GENDER:     Male / Female                                       Toilet Trained:          Yes / No

MOTHER’S NAME  ______________________________________________________

FATHER’S NAME  _______________________________________________________

GUARDIAN  ____________________________________________________________

ADDRESS  ______________________________________________________________

CITY  _______________________________________   ZIP CODE  ________________

PHONE NUMBER  ___________________________  EMAIL  ____________________

               

CLASS REQUEST:  Please indicate your preferences (1st, 2nd, 3rd)

            _____ Two Day Afternoon               T & TH            1:00 – 4:00 PM

            _____ Three Day Afternoon             M-W-F           1:00 – 4:00 PM

            _____ Four Day Afternoon               M & TH            1:00 – 4:00 PM

            _____ Five Day Afternoon                M – F              1:00 – 4:00 PM

            _____ Four Day Morning                M – TH           9:00 AM – Noon

            _____ Five Day Morning                   M – F              9:00 AM - Noon

            _____ Extended Day Preschool         Variable          8:00 AM – 5:00 PM

* Families requesting extended day preschool must complete an additional

registration form indicating the specific days/times desired.

               

Previous HeartPrints’ PRESCHOOL Family:            YES   /   NO

Previous HeartPrints’ SUMMER CAMP Family :     YES   /   NO

 

SPECIAL CONSIDERATIONS (Examples - Food allergies, medical conditions,

English as a second language):

 

 

 

 

               

A nonrefundable registration fee of $150.00 must accompany this form.

Checks should be made payable to HeartPrints.

               

DATE RECEIVED  ____________________                        HP STAFF  ____________________

FEES RECEIVED  _____________________                        CHECK NUMBER  _____________

LETTER SENT