Preschool Application - Preschool & Childcare Center Serving Tallahassee, FL

Student’s Name:(Required)

First Last

Prices:(Required)

Registration fee $100.00 / family (Non-refundable)

Material fee $150.00 / child annually

Age classroom (12m – 4 yrs. – Mon. – Fri. 7am – 6:30pm) $180.00 / week

Parent/Guardian Name:(Required)

Parent/Guardian Name:

Student’s Address:(Required)

Street Address City State ZIP Code

Parent/Guardian Phone:(Required)

Parent/Guardian Phone:

Parent Email:(Required)

Parent Email:

Child’s Date of Birth:(Required)

Sex:(Required)

Grade:

Age:(Required)

Student’s Starting Date:(Required)

ELC:(Required)

Yes

Method of Payment:

All payments will be processed through Brightwheel.

Tuition is billed weekly / Payable Monday morning before care is provided.

I,(Required)

, hereby acknowledge and agree to the following tuition terms for Gallop’s Family Center, Inc.:

By signing below, I confirm that I have read, understood, and agreed to the tuition terms as outlined above.

Signature:(Required)

Date(Required)

Are parents separated or divorced?(Required)

Who does the child live with?(Required)

Does your child have any allergies, food restrictions or medical problems?(Required)

If parents cannot be reached in an emergency situation, the following people should be contacted:(Required)

Name

Phone #

Alternate Phone #

Student’s Name

Guardian’s Phone #

SCHEDULE

Please provide the following information:

Typical Drop off time(Required)

Typical Pick-Up time(Required)

Diapers(Required)

Yes

Pull Ups(Required)

Yes

Potty Trained(Required)

Yes

RECEIPT OF CHILDCARE POLICIES

I have received and understand all the childcare policies provided to me in this registration packet. I agree to adhere to all policies and procedures outlined in this packet. I understand I must return these forms before registration is complete.

Parent Signature(Required)

Date(Required)

Please print name of parent(Required)

PHOTO RELEASE

I,(Required)

will mark the space below to grant or not grant permission of photos of my child to be used in the manner below.

Use still photos in promotional materials(Required)

Grant

Do not grant

Display still photos on facility’s website(Required)

Grant

Do not grant

Display in facility’s bulletin boards, show to current and prospective clients(Required)

Grant

Do not grant

SECURITY CAMERAS

To ensure the safety and security of all children, staff, parents, and visitors, as well as the security of our facility and premises, our center is equipped with a 24-hour video surveillance system. These security cameras are installed in classrooms, indoor and outdoor play areas, and common areas of the facility. Video surveillance is not conducted in private areas of the facility such as restrooms.

Because Gallop’s respects the privacy of all children, parents, and staff in our facility, our 24-hour video surveillance system/security cameras are for internal purposes only. Parents are not allowed to view or have copies of the recording. Recordings are only allowed to be viewed by the Administration, and licensing.

Signature(Required)

Date(Required)

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