VPK Application - Preschool & Childcare Center Serving Tallahassee, FL

Student’s Name:(Required)

First Last

Prices:(Required)

Registration fee (wrap and classroom only) - $100.00 (Non-refundable)

VPK full wrap (7:30 am – 6:15 pm). - $135.00 / week

VPK PT wrap (7:30 am – 2:30 pm). - $60.00 / week

VPK – 4yrs by Sept. 1st (9:00 am – 12:00 pm). - $FREE with a state VPK voucher

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 #

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

ATTENDANCE POLICY

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.

understand the VPK program requires a total of 540 hours during the school term. I commit to bringing my child to class on time and meeting the state requirements of attendance. I understand I will be required to sign a monthly statement certifying my child’s attendance in the program so that payment will be made to Gallop’s Family Center, Inc. from ELC. That statement of attendance is shown below.

I, (Name of Parent), swear (or affirm) that my child, (Name of Student) , attended the Voluntary Prekindergarten Education Program on the days listed above and certify that I continue to choose (Name of Provider or School) to deliver the program for my child and direct that program funds be paid to the provider or school for my child.

Signature of Parent:(Required)

Date(Required)