Child Enrollment Packet

School Year 2020-2021

Checklist:

⃝ Tuition and Fee Schedule

⃝ Enrollment Forms:

⃝ Student Information (one per child)

⃝ Family Information

⃝ Health and Medical Information

⃝ Emergency Contacts

⃝ Authorization and Concent (one per child)

⃝ Enrollment Contract

⃝ Georgia Immunization Form 3231

Amy Stephens, Director director@lilburnchristianpreschool.net

770-921-9688 lilburnchristianpreschool.net

A Ministry of Lilburn First Baptist Church

285 Main Street NW, Lilburn Georgia 30047 firstbaptist.net 770-921-1220

Tuition and

Fee Schedule

2020-2021

School Year

Class Age by Sept. 1st Days Monthly Tuition

Parents’ Morning Out 12-23 months M, W $165.00

2 years 2 years M-Th $230.00

3 years 3 years M-Th $230.00

4 years/Pre-K 4 years M-Th $230.00

Tuition Rates:

Annual Registration Fee $200.00

$150.00 (by April 30, 2020)

Late Payment Fee (after the 10th ) 10% of monthly tuition

Returned Check Fee $30.00

Late Pick-Up Fee $10.00 per occurrence; an additional

$5.00 per five minutes after 2:00pm.

Other Fees:

Please complete one form for each child you are enrolling at Lilburn Christian Preschool.

First, Last Name: Preferred Name:

Date of Birth: MM/DD/ YY Class: PMO 2 year 3 year 4 year/Pre-K Male / Female

Potty Trained? Yes

No Medications?

Allergies (Medical or Food):

Dietary Restrictions:

Impairments (vision, hearing, speech, mobility, other)

Has your child ever had a psychological or educational evaluation? Does your child favor use of his/her

Right /Left Hand? N/A? (circle one)

Has your child had experience interacting with other children? Please explain in detail.

Is there any significant information you would like to add which would contribute to a better understanding of your child and his/

her needs?

What do you hope your child will gain from a year at Lilburn Christian Preschool?

Is there anything else you would like us to know about your child (likes, dislikes, preferences, etc.)?

Student

Information

2020-2021

School Year

Mother Father Name: Name:

Address: Address:

City/Zip: City/Zip:

Email: Email:

Cell Phone: Text? Yes/No Cell Phone: Text? Yes/No

Work Phone: Work Phone:

Occupation:

Parents’ Marital Status (circle one): Married Divorced Single Widowed

Occupation:

Employer: Employer:

Custody Arrangements:

Siblings (names and ages):

Language Spoken at Home:___________________________ Other Languages:___________________________________________

How did you hear about us?

Other preschools your child(ren) has attended:

Child(ren):__________________________________________________________________________________________________

Family

Information

2020-2021

School Year

Family Pediatrician:

Pediatric Practice:

Address: City; Zip:

Phone: Fax:

Preferred Hospital:

Insurance Provider:

Insurance Company Phone Number:

Insurance Claims Address:

City: State: Zip:

Policy Holder:

Policy Number: Group Number:

Member ID:

***Please Note***

Lilburn Christian Preschool requires a current copy of your child’s Immunization Form 3231, which you obtain from your child’s pediatrician.

Child(ren):__________________________________________________________________________________________________

Health and

Medical Information

2020-2021

School Year

2020-2021

School Year

Please list up to four additional people who are authorized to pick up your child (other than parents)

The Following people are authorized to pick up the child from LCP and will be contacted in case of illness, accident, or

1 Name: Relationship:

Address: City: Zip:

Contact Phone: Email:

2 Name: Relationship:

Address: City: Zip:

Contact Phone: Email:

3 Name: Relationship:

Address: City: Zip:

Contact Phone: Email:

4 Name: Relationship:

Address: City: Zip:

Contact Phone: Email:

Child(ren)__________________________________________________________________________________________________

Emergency

Contacts

Authorization

and Consent

PARENTAL AGREEMENTS:

Medical Release:

In the event of an emergency, Lilburn Christian Preschool employees and/or agents will make every effort to contact me. Howev-

er, should I be unavailable, I do hereby grant permission for Lilburn Christian Preschool employees and/or agents to obtain emer-

gency medical attention in case of sickness or injury to my child, ________________________________________. I hereby grant

permission to said church preschool employees and/or agents to obtain service of a physician or to transport said child to the

hospital if it is deemed necessary. In consideration for you allowing my child to participate in Lilburn Christian Preschool: I hereby

release, absolve, indemnify, hold harmless, and forever discharge Lilburn First Baptist Church, Lilburn Christian Preschool, its em-

ployees, agents, or any supervisors appointed by them from any and all claims, demands, actions or cause of actions, past, pre-

sent, or future arising out of injury or damage to my child as result of emergency medical decisions made, in good faith, by Lilburn

Christian Preschool, its employees, agents or any supervisors appointed by them.

_____________________________________________________________ Parent Signature

Administration of Medication Policy:

I understand that Lilburn Christian Preschool employees and/or agents may not administer medications. Any medications,

prescriptions or otherwise, must be administered by the parent/guardian outside of school hours.

______________________________________________________________ Parent Signature

Holiday Schedule and Inclement Weather Policy:

I understand that Lilburn Christian Preschool follows the Gwinnett County School System calendar for Holidays, and follows their

guidance for inclement weather school closures.

______________________________________________________________ Parent Signature

Photo and Video Consent:

I give permission for myself and/or my child to be photographed or videoed during preschool hours and events and activities ei-

ther at or sponsored by Lilburn Christian Preschool and/or Lilburn First Baptist Church (herein abbreviated LCP/LFBC). I also grant

LCP/LFBC permission to publish and/or share my child’s name, picture, portrait, video and/or photograph in all forms and media

and in all manners, for display, publication, advertising, promotions, websites, and any other lawful purposes, taken of children

and adults during this event, on LCP/LFBC’s website and/or other LCP/LFBC publications/media. I waive any right that I may have

to inspect and/or approve the finished product(s) and I release, hold harmless, and covenant not to sue Lilburn Christian Pre-

school and/or Lilburn First Baptist Church, its agents, and employees from any and all liability, actions, claims, expenses, and dam-

ages on account of injury to me and/or my child related to the publication and/or sharing of the name, picture, portrait, video

and/or photograph.

______________________________________________________________ Parent Signature

I understand that Lilburn Christian Preschool is exempt from Bright from the Start state licensing.

______________________________________________________________ Parent Signature

Please complete one form for each child enrolling. Child:_______________________________________

2020-2021

School Year

Date:________________________________________

General Agreements:

I understand and agree that Lilburn Christian Preschool is not responsible for personal injury or loss of property. Lilburn Christian

Preschool, its director, employees, volunteers, and agents, as well as Lilburn First Baptist Church, are not responsible for reim-

bursement of any medical expenses incurred as a result of accidental incidents to a child or incidents between children resulting in

injuries that occur to a child or children during attendance at our preschool.

Lilburn Christian Preschool reserves the right to terminate a child after all resources have been exhausted to promote good behav-

ior. Lilburn Christian Preschool may dismiss a child from the program without notice, if in the opinion of the administration that it

is in the best interest of the child and the school. In addition, Lilburn Christian Preschool will terminate a child if tuition has not

been paid and no arrangements have been made with the director after two months. Families must register and pay fees to enroll

back into preschool (if there is availability).

I understand that all classes are subject to cancellation due to insufficient enrollment.

I understand the terms of this agreement are subject to change in whole or in part by Lilburn Christian Preschool without notice.

I understand that Lilburn Christian Preschool is not licensed by the state of Georgia and is exempt as a church school facility.

Financial Agreements:

I agree to pay the non-refundable registration fee at the time of enrollment.

I agree to pay tuition monthly in the amount as indicated in the tuition schedule. Tuition is due on the first of each month, August

through May, and a late fee of 10% will be assessed if not paid by the 10th of each month.

I agree that tuition will not be discounted or adjusted due to illness, holidays, vacation, or other absences.

In the case of withdrawal, I agree to provide written notice to the Preschool Director 30 days prior to the date of withdrawal. I un-

derstand I am responsible to pay the full amount of tuition up to and through the 30 day notification period.

I agree that a $30 fee will be charged for any check returned for insufficient funds.

I agree to a Late Pick-Up Fee of $10.00 per child, per occurrence, if my child is still present in the building after 1:45 p.m. An addi-

tional fee of $5.00 per five minutes will be charged if my child remains after 2:00pm. Legal authorities may be contacted if my child

is at the preschool for more than 2 hours after closing time, if the school is not contacted by the parent or guardian.

I have read, understand and agree to abide by the terms and conditions of this agreement as stated above.

Parent Signature:_____________________________________________________________Date:___________________________

Print Parent Name:____________________________________________________________

For Office Use Only:

Child 1: _____________________________________Class assigned:____________________________________

Child 2:_____________________________________Class assigned:____________________________________

Child 3:_____________________________________Class assigned:____________________________________

Registration Fee Paid: $___________ Cash ⃝ Check ⃝ Check/Receipt Number:___________________

Enrollment

Contract

2020-2021

School Year