The Preschool at Hyland Heights Registration

The Preschool at Hyland Heights operates as a ministry of the church, providing an evangelical, Christ-centered preschool ministry of love and care to families and young children.

Our program consists of age-appropriate developmental activities to nurture the child’s Spiritual, Social, Academic, and Physical Development in an atmosphere of Christian love, caring, and acceptance. At all times, we work toward the development and encouragement of a positive self-image in each child, helping the child to know he or she is special and that Jesus loves him or her in a special way.

REGISTRATION & TUITION

Registration Fee $65.00
2 yr olds $170.00/mo
2 1/2 & 3 yr olds $195.00/mo
4-year-olds $225.00/mo

To be considered for enrollment, registration must be submitted with the registration fee paid. **Once you register, you will receive an invoice with information on paying your registration fee.**
The class assignments will be based on availability.

If you have any questions please email office@hhbcpreschool.net or call 434-821-6005

Your name *

Email address *

Verify the child's birthdate *

Child being registered for the Preschool only.

Verify the child's full name *

Child being registered for the Preschool only.

Verify the child's Gender *

Child being registered for the Preschool only.

I am the... *

Phone number *

Address *

FAMILY INFORMATION

Please help complete any additional family members, including your spouse or the student's siblings.

Household members

****Include the child you are registering for preschool and any siblings.****

YOU MUST INCLUDE THE CHILD BEING REGISTERED HERE

Class Selection

Class Selection *

Parent's Marital Status *

Does either parent have sole custody of the student? *

Father's Occupation *

Mother's Occupation *

Please describe the general health of each family member listed above.

What religion do you align with the most? *

Protestants, Jewish, Catholic, etc. (or NA if not applicable)

EMERGENCY CONTACT

If parents cannot be reached in case of an emergency, please identify an emergency contact for your student.

Emergency Contact Full Name *

Emergency Contact Relationship to Student *

Emergency Contact's Address *

Emergency Contact's Phone *

ADDITIONAL STUDENT INFORMATION

Student's Birth Certificate Number

Are there any special needs for the student? *

"NA" if not applicable

Have there been any serious accidents in the student's life?

Does the student have any allergies? *

"NA" if not applicable

Has the student had any of the following immunizations?

DPT

Polio

Measles

Other

What are your student's dominant indoor play interests? *

What are your student's dominant outdoor play interests? *

Does your student eat well? *

Does your student sleep/nap well? *

Does the student cry easily? *

Does the student separate from parents easily? *

Is the student independent in his/her play habits? *

At what age did the student complete potty training? *

min: 0 / max: 16

In years

Is the student sensitive? *

Does the student have imaginary playmates? *

Does the student get easily frustrated? *

Does the student have playmates other than ones in school? *

Please list any additional information that will help The Preschool in working with your student so that he/she will feel safe and secure while in our care.

STUDENT'S PHYSICIAN

A physical form signed by your student's physician is required to enter preschool and is due in the office before the first day of school

Physician's Signed Form

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Student's Physician

Physician's Phone

AGREEMENTS & PERMISSION

I give permission for my child to receive emergency medical treatment by the Campbell County Rescue Squad. *

I acknowledge it is MY responsibility to notify The Preschool at Hyland Heights if any of the information in this form changes during the school year. *

Digital Signature *

I,_[FULL NAME BELOW]_, agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. This is to be used in conjunction with the use of electronic signatures on all forms regarding any and all future documentation with a signature requirement, should I elect to have signed electronically.

Type your full name in the box provided to sign this form.

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