Enrollment Form 2024-2025 Current Year

Information for Admission
Programs for 2024-2025

Two-Year-Old Program
Tuesday/Thursday AM ($325 monthly)
Monday/Wednesday/Friday ($475 monthly)

Three-Year-Old Programs
Monday/Wednesday/Friday AM ($425 monthly)

Monday through Friday AM ($630 monthly)

Four-Year-Old Programs
Monday through Friday AM ($630 monthly)

Five-Year-Old (Pre-K) Programs
Monday through Friday AM ($630 monthly)

After School Enrichment options

All after-school options are available for 3,4 and 5 year olds. They are all on a first-come, first-serve basis.

STEAM Plus and Literacy Plus are Preschool-run programs.

There are also three options available from 3rd Party partners that will be billed and reserved independently. By selecting one, or more 3^rd party partner option(s), you are merely expressing interest, not actually signing up for them at this point. This will help us determine the level of interest in these additional options. More information on the after-school enrichment options is available on our web site.

Preschool-run options:
STEAM Plus (Wednesdays) and Literacy Plus (Thursdays) run from 11:15 AM to 1:15 PM, and include nutritional lunch. The cost will be $175 a month, for either option.

3^rd Party Partner options:
Classes will run ten week sessions.

Tykes and Tunes (Mondays) runs from 11:25 AM to Noon and will cost $250.
Draw and Paint for Life with Maureen Claffy (Tuesdays) runs from 11:25 am to 1:25 PM and will cost $420.
Soccer Shots (Fridays) will run from 11:25 am to Noon and will cost $157.

Application Guidelines

The application process opens up to currently enrolled families and Hinsdale Covenant Church families in December, and to the public in January. We will maintain a waiting list. We reserve the right to cancel classes due to a lack of enrollment.

Children will be enrolled in appropriate classes based on their age on September 1. Children in classes for 3 year olds and up, must be completely toilet trained (no diapers or pull ups). Any children in those classes who have toileting accidents will have their parents called to change them.

An application and registration fee of $150 is required. Once their spot is confirmed, you will be billed for the 1st month tuition to secure their spot and that invoice will be due 2 weeks after the sent date. Once we receive their 1st month tuition payment, their spot is saved. It is not refundable after May 1.

Once your application, registration fee, tuition deposit, and state-required documents have been received and processed, you will receive an official confirmation of your child's enrollment.

Child's Basic information

Name

Gender

F M

Birthdate

Address

Class Request

TY First Choice Class Request

2 Day 2s 3 Day 2s 3 Day 3s 5 Day 3s 5 Day 4s PK

TY Second Choice Class Request

2 Day 2s 3 Day 2s 3 Day 3s 5 Day 3s 5 Day 4s PK

After School Enrichment Options

STEAM Plus (Wednesdays) and Literacy Plus (Thursdays) run from 11:15 AM to 1:15 PM, the cost will be $175 a month, for each individual option.

STEAM Plus TY

Yes No

Literacy Plus TY

Yes No

3rd Party Partner After School Enrichment Options

Choosing any of the next three options is just an expression of interest, not a commitment.
Tykes and Tunes will be held Mondays.
Draw and Paint for Life will be held Tuesdays.
Soccer Shots will be held Fridays.

Tykes and Tunes TY

Yes No

Draw and Paint for Life with Maureen Claffy TY

Yes No

Soccer Shots TY

Yes No

Parent/Guardian 1 Information

On all subsequent address fields, through the end of the form, please include City, State and Zip.

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

This address will receive a confirmation email

Phone

Parent/Guardian 1 Home Address (if different than child's)

Parent/Guardian 1 Name of Place of Employment (if applicable)

Parent/Guardian 1 Address of Place of Employment (if different than home)

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Work Hours

Parent/Guardian 2 Information

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Home Address (if different than child's)

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Parent/Guardian 2 Name of Place of Employment (if applicable)

Parent/Guardian 2 Address of Place of Employment (if different than home)

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Work Hours

Siblings

Please enter name, gender and birthdate of siblings.

Sibling 1 Name

Sibling 1 Gender F M

Sibling 1 Birthdate

Sibling 2 Name

Sibling 2 Gender F M

Sibling 2 Birthdate

Sibling 3 Name

Sibling 3 Gender F M

Sibling 3 Birthdate

Sibling 4 Name

Sibling 4 Gender F M

Sibling 4 BIrthdate

Caregiver Information (Nanny/Au Pair/Regular Babysitter)

Does your family employ a nanny, au pair, or regular babysitter?

Yes No

If you answered yes above then provide the information below, if you answered no, please put NA in each box

Caregiver Name

Pets

Does your family have any pets?

Yes No

If yes, please describe.

Pet detail

Physician Information

Physician/Practice Name

Physician Complete Address

Physician Phone

Emergency Contacts and Authorized Pick ups

Emergancy contacts, two are required by DCFS. They must have local addresses.

Authorized pick up
People, other than parents, authorized to pick your child up regularly and/or in the event of an emergency. This includes carpools. At least one primary and one contingency pick up person are required by DCFS.

Emergency Contact 1 Name

Emergency Contact 1 Local Address

Emergency Contact 1 Phone

Emergency Contact 1 Relationship to Child

Emergency Contact 2 Name

Emergency Contact 2 Local Address

Emergency Contact 2 Phone

Emergency Contact 2 Relationship to Child

Primary Pickup 1 Name

Primary Pickup 1 Address

Primary Pickup 1 Phone

Primary Pickup 1 Relationship to Child

Primary Pickup 2 Name

Primary Pickup 2 Address

Primary Pickup 2 Phone

Primary Pickup 2 Relationship to Child

Contingency Pickup 1 Name

Contingency Pickup 1 Address

Contingency Pickup 1 Phone

Contingency Pickup 1 Relationship to Child

Contingency Pickup 1 Contingency conditions

Primary not available other

Contingency Pickup 2 Name

Contingency Pickup 2 Address

Contingency Pickup 2 Phone

Contingency Pickup 2 Relationship to Child

Contingency Pickup 2 Contingency conditions Primary not available Other

About Your Child

What is your child’s favorite activity?

What is your child’s least favorite activity?

What child-oriented activities has your child participated in (Sunday School, story time, playgroups, for example)?

What is the family’s religious affiliation, and if applicable, home church?

Please describe your child’s general health:

Are there medical precautions the school should be aware of?

Yes No

If you answered yes, please describe in detail below, otherwise enter NA.

Medical Precautions Detail

Does your child have allergies to food?

Yes No

If you answered yes to the above, please describe any food allergies your child has, otherwise, enter NA.

Food Allergy detail

Does your child have allergies to insect bites or stings?

Yes No

If you answered yes, please describe in detail, otherwise, enter NA.

Bites and stings detail

Is your child receiving or has your child received any therapy interventions (occupation therapy or speech therapy, for example)?

Yes No

If you answered yes to the above, please describe in detail, otherwise, enter NA.

Therapy Intervention detail

Please include any additional information about your child or family that you wish for us to know, including therapies received and/or diagnoses.

Add. Information

Please enter the information necessary to pay the enrollment fee.

Enrollment fee $150

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Enrollment Form 2024-2025 Current Year

Description

Please Fix the Following