Preschool Sessions
(Please check your preference-Both sessions are identical.)
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Name of Pupil {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Home Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mom's Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Dad's Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name of Parent/s or Guardian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mom's Place of Employment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mom's Business Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Dad's Place of Employment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Dad's Business Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Person to contact in case of emergency (other than listed above) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Relationship to Child {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Emergency Home Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Emergency Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Child's Doctor {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Doctor's Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name you want child to learn to write/nickname? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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List other children in the home (Name, Age/Date of Birth, and Sex): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pets in the Home/Names {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Any allergies? (Food, insects, pets, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Any health problems diagnosed, including hearing or speech? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Untitled
Where? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Teacher {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What else can you tell us about your child as an individual? For example, what does he/she enjoy doing? Is he/she right or left handed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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The monthly payment is $120, due and payable on the first day of each month. Our budget is planned according to this amount; we cannot deduct anything for absence due to illness or otherwise. Please note: If Pennsylvania changes the minimum wage, tuition rates may be increased to maintain the same quality preschool as in the past. Please check this box that you understand this provision.
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I am enrolling my child in the Good Shepherd Preschool for the 2021-2022 school year for the 3 sessions per week @ $120 per month. I will be mailing the non-refundable registration fee of $50. Early withdrawal will require an additional two month tuition payment.
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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253 East Garfield Street, Shippensburg, PA 17257
(717) 532-6526 Celia Riess, Director