The Building Blocks Prep

Building Blocks Preschool and Kindergarten

For Office Use Only

Date Sent:_______________

Date Rec'd:______________


2014-2015 Registration rNew student  r Returning


Child’s Name: ______________________________________________________ D.O.B._____________________ Sex: F r M r

                                First                                     Last                          Middle

Child’s Address: ____________________________________________________________________________________________

                                  Street                                              City                                               State                                   Zip


Child's primary residence:______________________________________________________________



Mother/Guardian Name: ___________________________________________________ Home Phone: ___________________


Address: ___________________________________________________________________Cell Phone:______________________                   Street                                 City                                   State                 Zip


Employed By:______________________________________________________________ Phone: _________________________


Email Address:_____________________________________________________________



Father/Guardian Name:____________________________________________________ Home Phone: ___________________


Address: ___________________________________________________________________Cell Phone: ____________________

                  Street                                  City                                   State                 Zip


Employed By:______________________________________________________________ Phone:_________________________


Email Address:_____________________________________________________________


Do you have another child registered at Building Blocks/The Prep?  Child's Name:________________________________


Please Check Appropriate Boxes: (Extended Hours: Any part of 7:00-8:45)


r Half M-F (8:45-12:30)               r Half M-W-F (8:45-12:30)            r Half T-TH (8:45-12:30)


r Full M-F (7:00-8:45) 4:00    r Full M-W-F (7:00-8:45) 4:00   r Full T-TH (7:00-8:45) 4:00


r Full M-F (7:00-8:45) 5:00    r Full M-W-F (7:00-8:45) 5:00   r Full T-TH (7:00-8:45) 5:00


Kindergarten: (Age 5 by September 1, 2013


r Half M-F (8:45-12:30)     r Full M-F (7:00-8:45) 4:00    r Full M-F (7:00-8:45) 5:00

I agree to:

  • *A non-refundable $50 registration fee with this application for new students, returning students and siblings.

  • No credit will be given for absences due to illness and tuition must continue to be paid.

  • Tuition is not charged for 3 weeks throughout the school year. These vacations are Christmas, February vacation and April vacation.

  • Tuition is due one week in advance throughout the year payable on Thursdays or Fridays for the following week. You may elect to pay weekly or bi-weekly.

  • We are open when Lowell Public schools are open. If Lowell Public school is cancelled because of weather, we will be closed.  We do not have delayed openings, we will be open at regular time.

  • In case of withdrawal of my child from the center, I agree to give the center a two-week notice prior to withdrawal. A new enrollment fee and deposit will be required should the child re-enroll at a later date.

Parent Signature:__________________________________________________ Date:____________________________________

548 Clark Road, Tewksbury, MA 01876  (978)640-2565 ~ (978)735-4517