Enrollment Form 2025-2026

Information for Admission
Programs for 2025-2026

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

Three-Year-Old Programs
Monday/Wednesday/Friday AM ($475 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:

For 3 Year Olds:
STEAM Plus Lunch (Wednesdays) and Literacy Plus Lunch (Thursdays) run from 11:15 AM to 1:30 PM, and include a nutritional lunch. The cost will be $185 per day/per month.

For 4 Year Olds and PK:
PK Enrichment plus Lunch (T-W-Th) run from 11:15 AM to 2:00 PM, and include a nutritional lunch. The cost will be $580 a month.

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 1st. 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 your child's 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.

IMPORTANT NOTE: DCFS requires certain complete information. Therefore, ALL Child, Parent, Physician and Authorized Pick Up persons, primary and contingency, information needs to be complete. This includes names, addresses and phone numbers. If ANY of this information is missing the application will not be deemed valid and your child's placement may be jeopardized.

Child's Basic information

Name

Gender

F M

Birthdate

Address

Class Request

First Choice Class Request

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

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 Lunch, Literacy Plus Lunch and PK Enrich Plus Lunch)

3 year old option- STEAM Plus Lunch (Wednesdays) and Literacy Plus Lunch(Thursdays) run from 11:15 AM to 1:30 PM, the cost will be $185 a month, for each individual option.

4/5 year old option- PK Enrichment Plus Lunch (T-W-TH) will run from 11:15 to 2:00 PM. The cost will be $580.

3rd party enrichment options (Music, Art and Soccer) will be sent at a later date by the 3rd party providers.

STEAM Plus Lunch NY

Yes No

Literacy Plus Lunch NY

Yes No

PK Enrich Plus Lunch NY

Yes No

Parent/Guardian 1 Information

In parental addres fields if home is same as childs, just enter "same"

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

This address will receive a confirmation email

Phone

Only enter address, city, state and zip code if different from child's home address. Otherwise enter "same". For address information on place of employment only enter if different than childs home, otherwise you can enter "same" or "NA".

Parent/Guardian 1 Home Address

Parent/Guardian 1 Home City

Parent/Guardian 1 Home State

Parent/Guardian 1 Home Zip

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

Parent/Guardian 1 Address of Place of Employment

Parent/Guardian 1 Place of Employment City

Parent/Guardian 1 Place of Employment State

Parent/Guardian 1 Place of Employment Zip

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Work Hours

Parent 1 Work Email

Parent/Guardian 2 Information

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Only enter address, city, state and zip code if different from child's home address. Otherwise enter "same". For address information on place of employment, only enter if different than child's home, otherwise you can enter "same" or "NA".

Parent/Guardian 2 Home Address

Parent/Guardian 2 Home City

Parent/Guardian 2 Home State

Parent/Guardian 2 Home Zip

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

Parent/Guardian 2 Place of Employment City

Parent/Guardian 2 Place of Employment State

Parent/Guardian 2 Place of Employment Zip

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Work Hours

Parent 2 Work Email

Physician Information

Physician/Practice Name

Physician Complete Address

Physician City

Physician State

Physician Zip

Physician Phone

Emergency Contacts and Authorized Pick ups

Emergency contacts, two, are required by DCFS. They must have local addresses complete with city, state and zip code. Emergency contacts must be someone other than parents, must be local and are the person(s) to call if the parent cannot be reached.

Authorized pick up people, other than parents, authorized to pick your child up regularly and/or as a contingency (primary picks ups not available). This includes carpools. At least one primary and one contingency pick up person are required by DCFS. They must have complete addresses complete with city, state and zip code on this enrollment form.

Emergency Contact 1 Name

Emergency Contact 1 Local Address

Emergency Contact 1 City

Emergency Contact 1 State

Emergency Contact 1 Zip

Emergency Contact 1 Phone

Emergency Contact 1 Relationship to Child

Emergency Contact 2 Name

Emergency Contact 2 Local Address

Emergency Contact 2 City

Emergency Contact 2 State

Emergency Contact 2 Zip

Emergency Contact 2 Phone

Emergency Contact 2 Relationship to Child

Primary Pickup 1 Name

Primary Pickup 1 Address

Primary Pickup 1 City

Primary Pickup 1 State

Primary Pickup 1 Zip

Primary Pickup 1 Phone

Primary Pickup 1 Relationship to Child

Contingency Pickup 1 Name

Contingency Pickup 1 Address

Contingency Pickup 1 City

Contingency Pickup 1 State

Contingency Pickup 1 Zip

Contingency Pickup 1 Phone

Contingency Pickup 1 Relationship to Child

Siblings

Please enter name of siblings.

Sibling 1 Name

Sibling 2 Name

Sibling 3 Name

Sibling 4 Name

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:

Dietary restrictions

Yes No

If you answered 'yes' to Dietary restrictions, please describe in detail below, otherwise enter NA.

Dietary restrictions list

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

Pets

Does your family have any pets?

Yes No

If yes, please describe.

Pets 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 2025-2026

Description

Please Fix the Following