Preschool Application

Student’s Name:(Required)
Parent/Guardian Name:(Required)
Parent/Guardian Name:
Student’s Address:(Required)
Child’s Date of Birth:(Required)
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Method of Payment:

All payments will be processed through Brightwheel.

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

, 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.

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


Please provide the following information:
Typical Drop off time(Required)
Typical Pick-Up time(Required)
Pull Ups(Required)
Potty Trained(Required)


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.
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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)
Display still photos on facility’s website(Required)
Display in facility’s bulletin boards, show to current and prospective clients(Required)


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.
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