Summer Camp 2025 Registration — New Philadelphia Moravian Preschool

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name

First Name

Last Name

Child's Birth Date

Child's Age(s) on August 31, 2024

Week Selection

Week 1 (June 2-6)

Week 2 (June 9-13)

Week 3 (June 16-20)

Parent Information

Parent/Guardian #1

First Name

Last Name

Parent/Guardian #2

First Name

Last Name

Parents Are

If there is a custody order, a copy of the order is required to be on file in our office.

Child Lives With:

Emergency Info

Emergency Contact #1

First Name

Last Name

Emergency Contact #2

First Name

Last Name

Do you give permission for emergency contacts to pick up your child?

Financial Policies

Registration fee is due by Feb. 10, 2025 and is nonrefundable. All accounts must be current to register for summer camp. Camp tuition will be due by May 10, 2025. Current families will have the option to have this ACH drafted. Returned check/ACH payments are subject to a fee of $30. Two returned checks/ACH payments will result in having to pay by certified check or cash. Travel is an important part of our lives. However, we do not make tuition payment exceptions due to travel. Health forms and immunization records are required every school year, even for children who attended the prior year. Current families' health forms will still be valid, and new families will need to turn health forms in by the first day of camp your child attends. Late pick ups (after 1 pm) will result in a $10 late fee for the first incident, $15 for the second incident, and $20 for the third. For late pickups that occur more than 10 minutes after the late cut off, the fee for the incident automatically increases to $20, and $5 will be added to that fee for each additional 5 minutes of wait time. Please note that state law forbids us from keeping children more than 4 hours – please help us comply with this by being timely with pickup. Hardships do arise. Please contact our office if you are experiencing a financial or medical hardship as it relates to tuition or attendance to discuss alternative arrangements. I understand the information regarding financial policies for New Philadelphia Moravian Preschool. I have read and understood the information on this sheet.

I understand the information regarding financial policies for New Philadelphia Moravian Preschool. I have read and understood the information on this sheet.

Please type your full name to acknowledge that you have read and agree to the financial policies stated above.

Date

YYYY

Student Information

Tell us about your child! Any major fears, special interests, or favorite activities?

Has your child been in a preschool setting before?

Yes

Is your child currently under a doctor's care or on daily medication? If yes, please explain.

History of significant disease or recurrent illness? If yes, what and when?

Any disabilities or developmental delays? If yes, please explain.

Is your child receiving any of the following: speech therapy, physical therapy, occupational therapy, and/or counseling? If yes, please explain.

Any food allergies or dietary limitations? (If a food allergy is present, an action plan must be completed by child's physician)

Please list any serious allergies. (If your child carries an Epipen/Auvi-Q at school, an action plan must be completed by child's physician)

Does your child have any of the following conditions?

Asthma (If child carries an inhaler at school an action plan must be completed by physician)

Diabetes

Hepatitis

Epilepsy/Seizure Disorder

Hearing Issues

Heart Condition

Vision Issues

Blood Disorder

Other

If yes to any of the immediate above, please explain

Name of Pediatrician/Practice

I am registering my child for Summer Camp at New Philadelphia Moravian Preschool. I understand this form is valid once signed and submitted.

First Name

Last Name

Date

YYYY

Thank you for submitting registration for Summer Camp 2025 at New Philadelphia Moravian Preschool!

Please look out in your email soon for next steps and information regarding the registration fee. Your spot is not secured until the registration fee has been paid.

Please email or call our office regarding any registration questions or concerns.

Thank you!

Summer Camp

Registration 2025!

Summer Camp Registration Form

Location

Hours

Contact