2023 Preschool Registration

Preschool Online Registration

Class Registration

FOR 3-YEAR-OLDS: Please choose the class you would like for your child (child must be 3-years-old by September 1st, 2023)

Tuesday/Thursday - $195/month

Monday/Wednesday/Friday - $270/month

Monday through Friday - $400/month

FOR 4-YEAR-OLDS/5-YEAR-OLDS: Please choose the class you would like for your child (child must be 4-years-old by September 1st, 2023). 3-day & 5-day classes are currently full. Please email mlascurain@ywcacarlisle.org to be added to our waiting list.

Tuesday/Thursday - $195/month

Child's Information

Child's Name(Required)

First Last

Child's Age(Required)

Child's Birthdate(Required)

Child's Gender Identity(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Demographics - please select all that apply(Required)

African American/Black

Asian American/Pacific Islander

Hispanic/Latinx

Native American

White/Caucasian

Prefer not to answer

Primary Language Spoken at Home(Required)

Does your child have any special needs or does your child receive any therapies/support services from the Capital Area Intermediate Unit (CAIU) for early childhood intervention?(Required)

Please list any therapists/support providers that may be working with your child during school.

Phone for any therapists/support service providers for your child.

Has your child exhibited any barriers to learning (including anxiety, language skills/speech, running away, aggression, physical limitations, social limitations, etc.)?

Is this your child's first experience in a school setting or group?(Required)

Yes

Is this your child's first time away from parent/guardian or direct member of your family (like grandparents, relatives, etc.)?(Required)

Yes

Would you like information on our scholarship program?(Required)

Yes

Parent/Guardian Information

Parents/Guardians Name(Required)

First Last

Phone

Employer

Work Phone

Additional Parent/Guardian Info (if applicable)

First Last

Phone

Address (if not the same as parent/guardian listed above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer

Work Phone

Emergency Contacts - In the event that parent/guardian cannot be reached, please list 2 emergency contacts for your child.

Name of Emergency Contact #1(Required)

Emergency Contact #1 Phone(Required)

Name of Emergency Contact #2(Required)

Emergency Contact #2 Phone(Required)

People Authorized to Pick Up My Child - Photo ID required at time of pick up

Pick Up Person #1

Pick Up Person #1 Phone

Pick Up Person #2

Pick Up Person #2 Phone

Pick Up Person #3

Pick Up Person #3 Phone

Child's Health Information

Please list any allergies or medical conditions.

Please list any prescriptions to be kept at school (doctor's form required).

Does your child have an EPIPEN?

Yes

Doctor's Name

Doctor's Phone #

Is your child covered by insurance?(Required)

Yes

Primary Health Insurance Provider:

Insurance Provider Phone #

Insurance Identification #

Insurance Group #

Dentist's Name

Dentist's Phone #

RELEASE INFORMATION

I understand that, in the event of an emergency involving my child, it may be necessary for a staff person or other representative of YWCA Carlisle to administer basic first aid to my child and/or transport my child to a hospital, physician's office or other health care facility. I hereby consent to the treatment and/or transportation of my child under such circumstances, and release YWCA Carlisle, its employees, director and agents from any claim arising out of or related to such treatment or transportation, except in the case of gross negligence. I will bear all expenses incurred in transportation and medical treatment.(Required)

A check in this box signifies your consent.

I do not consent. (Regrettably, your child will not be able to attend preschool. Please contact the Director with questions).

Additional Releases - Please check any and all boxes that apply:(Required)

I give permission for my child to be photographed for classroom projects, activities, and special events.

I give permission for my child’s photo to be used on the school website, on all YWCA Carlisle & Cumberland County social media accounts, marketing materials, and other school promotions, both print and electronic (including, but not limited to YWCA Carlisle’s annual report), understanding my child’s name will not be displayed.

I give my permission for my/my child's contact information to be distributed to my child's class for the purpose of contacting classmates for play dates and birthday parties.

I hereby agree to give YWCA Carlisle & Cumberland County two (2) weeks notice of withdrawal of my child and understand I forfeit any paid tuition if I do not give such notice and complete a withdrawal form for my child prior to their last day of school.

I hereby agree to abide by the YWCA Little Wonder’s Preschool fee policies, including paying a late pick up fee of $1.00 per minute after 5 minutes late, paying my tuition by the 15th of the month prior to service, paying a $15 late fee if monthly payment is not received by the 25th the month prior to service, and that my child cannot attend classes for any unpaid dates until payment has been made. I understand that my child’s spot in the preschool is only guaranteed for one week of non-payment unless a written payment agreement is reached with the preschool director and signed by both the preschool director and a parent or guardian of my child.

How did you hear about us?

Social Media (Facebook, Instagram, LinkedIn)

Website

Other

REGISTRATION FEE: Registration fee will hold your child's spot in the class, and will also register your family as members of the YWCA Carlisle & Cumberland County as required in the parent handbook.

Please choose the class that your child will be attending:

Monday/Wednesday/Friday

Tuesday/Thursday (3-year-old-class only)

Monday thru Friday

Total

Method of Payment

I will pay my registration fee by credit card (see below)

I will pay my registration fee by check (understanding that your child's spot in a class cannot be guaranteed until check is received by YWCA Carlisle). Check should be mailed to YWCA Carlisle, Attn: Thomas Kohutiak, 301 G Street, Carlisle PA 17013.

Credit Card

Cardholder Name

Card Details

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