The Building Blocks Prep

Building Blocks Preschool and Kindergarten

For Office Use Only

Date Sent:_______________

Date Rec'd:______________

Reg._____________________

2012-2013 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, 2012)

 

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