883 Highway 34,
Phone: 732-566-9246
Email: presbyns@optonline.net
www.fpc-matawan.org
APPLICATION FOR ADMISSION
Child’s Name
_____________________________ Child is
called ________________ Sex __________
Address
______________________________________City_______________________Zip__________
Phone Number ________________________
Date of Birth (Child
must be 3 or 4 by October 1 to be eligible for THREES and FOURS program,
respectively) ___________________
Names and Ages of Siblings
______________________________________________________________
Previous school experience?
______________ If “yes,” please specify ____________________________
How did you learn of PNS?
_______________________________________________________________
Why have you chosen to enroll your
child in PNS? _____________________________________________
_____________________________________________________________________________________
Father’s Name
___________________________ Mother’s
Name _______________________________
Address
________________________________ Address
_____________________________________
_______________________________________ ____________________________________________
Home Phone
____________________________ Home
Phone __________________________________
Cell Phone
______________________________ Cell
Phone ____________________________________
Occupation
______________________________ Occupation
___________________________________
Business Name & Address
__________________ Business Name
& Address _______________________
________________________________________ _____________________________________________
Business Phone ___________________________ Business Phone ________________________________
Email Address
____________________________ Email
Address _________________________________
List two persons (residing
within the area served by PNS) authorized to be contacted and/or to pick up
child IN CASE OF EMERGENCY if neither parent can be contacted. State relationship, address, phone for each:
____________________________________________________________________________
____________________________________________________________________________
List the name, address, and phone
number of child’s physician: ___________________________________
_________________________________________________________________________________
(complete other side also)
Indicate type of program desired:
Please mark FIRST
CHOICE with a #1, SECOND CHOICE with a #2, and THIRD CHOICE with a #3.
AM classes meet from
(Transitional Threes:
|
THREES 2008-2009 school year |
PRE-K FOURS 2008-2009 school year |
|
Transitional ________ ($1000/year) |
3-day AM: Tues., Th., Fri. ________ ($2250/year) |
|
Adult stays with child
through mid year, then co-ops approximately once a month |
Adult co-ops approximately
12 times/year in 3-day class |
|
|
3-day PM: Tues., Th., Fri. ________ ($2250/year) |
|
|
|
|
2-day AM:
Mon., Wed. ________($1500/year) |
|
|
Tues., Th. ________ ($1500/year) |
4-day PM:
Tues., Wed., Th., Fri.______($3000/year) |
|
2-day PM: Mon., Wed.
________($1500/year) Adult co-ops approximately
9 times/year in 2-day class |
Adult co-ops approximately
15 times/year in 4-day class |
|
|
|
|
|
4-day PM: Half co-op _______($3175/year) |
|
3-day AM:
Mon., Wed., Fri. ______ ($2250/year) |
Co-op 7 times/year |
|
Adult co-ops approximately
12 times/year in 3-day class |
|
|
|
4-day PM: Non co-op. _______($3375/year) |
|
|
No co-op days required |
|
|
|
|
|
Extended hour: 1, 2, or 3 days/week |
|
|
Occasionally @
$15/day___ Monthly @ $10/day___ |
|
|
All year @ $8/day____ |
With this application, I
grant permission for my child to use all the equipment and participate in all
the activities of the School. With this
application, I authorize the Director or Teacher, if unable to contact a parent
or emergency person, to obtain any emergency medical treatment that may be
warranted for my child.
Upon
my child’s enrollment, I agree to serve as a teacher’s assistant in my child’s
classroom several days each Quarter, (except those choosing the “non co-op”
class).
I
agree to provide, by my child’s entry date, a completed Health Form signed by
my child’s licensed physician, certifying immunization record and results of an
exam given within six months prior to entry date.
I am
enclosing a non-refundable $40 Registration Fee ($20 if re-registering) and a
$50 Advanced Tuition Payment. This $50
payment is fully refundable if PNS is notified of a change in enrollment plans
prior to August 15.
Signature
_______________________________________________________ Date ___________________
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Should a non-custodial parent
or guardian be legally prevented from taking custody of this child, please so
indicate; and provide PNS with a copy of the Court Order. State name, address and relationship of such
person below.
_____________________________________________________________________________
Signature of person making this statement
_____________________________________________
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Office use: Reg. Fee Pd.____ Adv. Tuit. Pd.____ W/D Date____
Ref. Pd. ____