HOPE Preschool

HOPE Preschool 43454 Crossroads Drive, Ashburn, VA 20147
Application/Registration Form 2012-2013 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 9/30/12:   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

Sandra Rolston Scholarship: Limited financial need based scholarships are available. See the HOPE Director for application.

CHECK HERE if your 1^st 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

• CHILD MUST BE TOILET TRAINED BY AUGUST 1, 2012
• Children may not attend HOPE as a supplement to Kindergarten
• BIRTH CERTIFICATE MUST ACCOMPANY REGISTRATION FEE

No money is due UNTIL your child is offered a placement at HOPE or you have drawn a lottery number. 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 begin AUGUST and continue through APRIL. If the first tuition payment is not received by August 1^st, 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.