Enrollment Application

Hearts 'N Hands

Child Care and Preschool

730 Preston Lane, Hatboro, Pa. 19040
215-672-1576      

http://www.heartsnhandschildcare.com/

______________________________________________________________________


Date of Application ___________ Date of Admission ______________   

Age at Admission  _________ Name of Child ____________________

Date of Birth _____________    Primary Language ___________

Home Address/Zip ___________________________________________________

Parent #1 Name ________________________________________   

Telephone (____)________________

                                                                                                           

Address ________________________________________

                                     

               ___________________________________________  

Cellphone  (____)________________   

Parent #1 Company Name ___________________________________      

Telephone (____)________________

Address ___________________________________________________     

Parent #2 Name ___________________________________________    

Telephone _(____)_______________

                                                                                                           

Address___________________________________________

                       

              ___________________________________________       

Cellphone  (____)_______________

Parent #2 Company Name ___________________________________      

Telephone _(____)_______________

 Address ___________________________________________________________         

           

Parent #1 Work Schedule ___________________         

Parent #2 Work Schedule _______________________

Identifying Information (required by state)

            Eye Color: __________       Hair Color: ___________   Sex: _______________
    
           Height:  ____________      Weight: ______________    Race: _______________   

           Identifying Marks:  ____________________________

I, ___________________________,                  

             (Parent/Guardian)

wish to enroll ___________________________ in the “Hearts ‘n Hands”

Child Care & Preschool Program for the following schedule:

Monday                Tuesday               Wednesday          Thursday              Friday

Arrive:________   Arrive:________  Arrive:________   Arrive: _______    Arrive:  _______
Depart: _______  Depart: _______  Depart: _______  Depart: _______   Depart: _______    

Enclosed is the annual registration fee of $40.00 and one week of tuition in the amount
of $_______ as a deposit.  I understand that both fees are non-refundable if my child is
enrolled.  I have read and understood all policy and tuition information and agree to comply. 
Hearts ‘n Hands Child Care and Preschool provides services to children and families regardless
of their race, religion, gender, and cultural heritage, political beliefs, parents’ marital status,
sexual orientation, national origin, or disability.

  

 _________________________________________________

          Signature of Parent/Guardian                                    Date

Hearts ‘n Hands Child care and Preschool provides services to children and families

regardless of their race, religion, gender, cultural heritage, political beliefs, national

origin, parents’ marital status, disability, or sexual orientation.  We are a Christian day

care sponsored by the Hatboro Community Methodist Church, and our curriculum will

include teaching Christian values along with the basic preschool curriculum.