Our Savior Preschool and Child Care

PART DAY PRESCHOOL 2008-2009

Registration Fee:__ Date Rec’d:_ Check #_ Cash

First Month’s Tuition payment Date _ Check # _

Starting Date:__________

Our Savior Preschool and Child Care

239 Graham Road

South Windsor, CT 06074

860-644-6458

2008-2009 PART DAY PRESCHOOL REGISTRATION FORM

(One form per child.)

Welcome to OSPCC! To register your child, please return this completed form to OSPCC with a non-refundable registration fee of $50.00 per family (or $30.00 returning family if registered by February 15^th, 2008). When your registration form and fee are received, you will be contacted by the Director regarding the enrollment process. All paperwork must be received three full business days prior to admittance.

2008-2009 PROGRAM (Please Circle One) Bear Cubs Galloping Giraffes Zippy Zebras Roaring Lions 4 or 5 days

STUDENT INFORMATION

Full Name ___________________________ Preferred Name _

Permanent Address _______________________________________________________________________________

City _____________________________________________ State ____________________ Zip _________________

Telephone Number ___________________________ Date of Birth ___________________ Male _____ Female _____

Age by 9/1/08 (Years: _______ Months: _______) Grade entering _________ School/Future School ______________

Language your child is most comfortable speaking. _____________________________________________________

Does your child have health insurance? ________________________________ With Whom: ____________________

Health concerns, allergies, existing conditions, regular medications taken,____________________________________

______________________________________________________________________________________________________________________________________________________________________________________________

RELIGION

________Lutheran ________Catholic ________Other; Denomination ________________________

Church Name: _________________________ No church affiliation____ Looking for a church home______

PARENT/GUARDIAN/FAMILY INFORMATION

Name ____________________________________________________ Relationship __________________________

Street Address ___________________________________E-mail address__________________________________

City _____________________________________________ State __________________ Zip __________________

Home Telephone ______________________________ Business Telephone _________________________________

Company ____________________________________ Occupation/Title ___________________________________

Work Address _________________________________________________________________________________

Name ___________________________________________________ Relationship ___________________________

Street Address ___________________________________E-mail address___________________________________

City _____________________________________________ State __________________ Zip __________________

Home Telephone ______________________________ Business Telephone _________________________________

Company ____________________________________ Occupation/Title ___________________________________

Work Address __________________________________________________________________________________

Are parents: Married: ______ Divorced: ______ Separated: _____ Single Parent: ______

With whom does the applicant reside? ______________________________________________________________

Names of other children

Name _______________________ School Grade/Age _

Name ___________________________________ School __________________ Grade/Age ___________

How did you hear about OSPCC? _________________________________________________________________

Other comments or concerns______________________________________________________________________