HOPE Preschool 43454 Crossroads Drive, Ashburn, VA 20147 Application/Registration Form 2013-2014 School Year PUBLIC FORM - This form is ONLY for families who have had no prior affiliation with HOPE
* denotes a required response
Today's Date: *
Child's LAST NAME: * Child's FIRST NAME: *
Sex: Male Female*
Date of birth: *
Age as of 9/30/13: yrs months*
Parents: * Home Phone: * Address: * City: * State: * Zip: *
Mother's Business/Cell Phone Number: * Father's Business/Cell Phone Number: *
Email Address: *
Has your child been referred for any supplemental services such as speech, OT, PT, vision, etc.? Yes No*
For placement purposes only. Which service(s) is your child receiving?
Diagnosed food allergies? Yes No* (If Yes: ) Epi-pen? Yes No
Class Choices need to be numbered in order of preference (1, 2, 3, 4, 5, 6) from the appropriate age group.
Date of Birth 10/1/07 - 9/30/09 (4-5 YR Old)
T/TH AM MWF AM M-Th AM M-F AM MTW PM M-Th PM
Date of Birth 10/1/09 - 3/31/10 (3 ½ YR Old) T/Th AM MWF AM
Date of Birth 4/1/10 - 9/30/10 (3 YR Old) M/W AM T/Th AM
Sandra Rolston Scholarship: Limited financial need based scholarships are available. See the HOPE Director for application.
CHECK HERE if your 1st choice is to coordinate your HOPE children's schedules IF POSSIBLE Yes
CLASS TIMES: 9 to 11:45 AM & 12:45 to 3:30 PM
No money is due UNTIL your child is offered a placement at HOPE. At that time, the $125 non-refundable fee and registration form will be accepted and processed. In return, we expect you will honor your enrollment for the entire term unless you move or have unforseen circumstances.
Tuition payments (9 total) begin AUGUST and continue through APRIL. If the first tuition payment is not received by August 1st, your registration fee and class placement will be forfeited.
Incomplete forms or forms without birth certificates will not be processed.
By typing your name as your signature in the following box, you are certifying that all information above is complete and accurate.