ENROLLMENT APPLICATION Childs' Name Date of Birth01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 2025202420232022202120202019201820172016201520142013201220112010year Age GenderMaleFemale Has your child been to a Preschool before? If Yes, Where and for How long?Please check the appropriate program Schedule & Meal PatternFull Time 5 days a week Monthly $Full Time 5 daysSelect value$10$20$30$40$50$60$70$80$90$100 Weekly $Full Time 5 daysSelect valueoption 1option 2Part Time 3 days a week* Monthly $Part Time 3 daysSelect valueoption 1option 2 Weekly $Part Time 3 daysSelect valueoption 1option 2Part Time 2 days a week* Monthly $ Part Time 2 daysSelect valueoption 1option 2 Weekly $Part Time 2 daysSelect valueoption 1option 2 MatrixMondayTuesdayWednesdayThursdayFridayBreakfastLunchSnack Matrix(1)Hours of Care (ex 9-5) Request starting date How did you hear about usPARENT / GUARDIAN INFORMATIONMother's Information Mother's Name Social Security # DL # Address City State Zip Email Home Phone Place of Employment Cell Phone Job Title Work PhoneFather's Information Fathers's Name Social Security #Father DL #Father AddressFather CityFather StateFather ZipFather EmailFather Home PhoneFather Place of EmploymentFather Cell PhoneFather Job TitleFather Work PhoneFather Custody Information Marital StatusSelect valueSingleMarried List any allergies your child has My child excels in My child needs help in Parent's evaluation of child's personality Does your child have any special needs/problems/fears? Additional information we should know about your childReturn this completed application with your enrollment fees as soon aspossible to reserve your child's space. Enrollment fees do not include yourfirst week's tuitionI understand I am signing up for specific days and times and I am responsible for Payment according to the school policyI understand that the enrollment fees are non-refundable. Date Parent/Guardian's SignatureClearPasadena Preschool AcademyPreschool Toilet Training Plan Childs Name: Birth Date: Todays Date:Toileting Plan 1. How many wet diapers a day approx.: 2. How often does your child have a bowel movement: 3. Any special comments or concerns in reference to diapering/toileting: 4. Method preferred for toilet training: 5. Specific equipment used and time line of use as directed/provided by parent as well as a timeline of introduction of appropriate clothing:All parents are asked to please provide diapers and wipes for their child, as well as anyointments, powders, etc. that may be preferred by the parent. Please make sure all supplies areclearly labeled with your child's name.I have discussed my infant's needs and services plan with the center's Director and agree withthe information provided here. I will notify the Director immediately of any changes in the needsof my child. Parents Name Date(Toilet planing) Center Representative: Daytime Phone# : DateToilet planing 2 Signature (Toilet planing)ClearPasadena Preschool Academy1834 W. Valencia Dr.Fullerton, CA 92833Phone: 714-525-7377Fax: 714-525-3985Pasadena Preschool Academy uses Remind, a text messaging/email service, to send outimportant reminders and/or safety alerts if ever needed. If you would like to be signed up forRemind text messages/emails please provide your name and preferred cell phone number andor email below. One or both Parents are welcome to sign up. This program is forPARENTS/GUARDIANS ONLY.Please be aware this is a one way form of communication, no responses to Remind messages will be received by Pasadena Preschool Academy. Please always call the center directly or stop by the office if you have any questions or concerns. Child's Name: Classroom: Contact 1 Contact 1 Name Contact 1 Cell Phone # Email1Contact 2 Contact 2 Name Contact 2 Cell Phone # Email2PreSchool Supply ListParents please make sure to supply your child's teacher with thefollowing supplies. If your child is running low on a specific item theywill notify you verbally or by sending home a note.1 standard crib sheet & thin blanket in a clear bag- to be senthome on Fridays for laundering. Need to be brought back at thebeginning of the week. Please put name on sheets. At least 2 pairs of extra clothes in a clear bag with name onclothes. Pencil box with name (Crayons, markers pencils, Elmer's glue)POTTY TRAINING: Sleeve of diapers/pull ups with name onbag and wipes. OPTIONAL:Water bottle/sippy cup with name and current datePlease remember any item brought the classroom MUST be labeledwith your child's name. Thank you!Please remember any item brought into the infant/toddler classroom MUST be labeled with your child's name. Any food or bottle itemshould be labeled with the child's ·name as well as the date it wasbrought in; your child's teacher can assist you with this.SubmitReset
