2018/2019 2460 Potters Road School Programs Virginia Beach...
Transcript of 2018/2019 2460 Potters Road School Programs Virginia Beach...
2018/2019
School Programs
10:00 a.m. - 2:00 p.m.
2460 Potters Road
Virginia Beach, VA 23454
757-486-7907
Fax# 757-486-3178
www.lbbp.londonbridge.org
5 Day Class $340.00 monthly
4 Day Class $295.00 monthly
3 Day Class $270.00 monthly
2 Day Class $225.00 monthly
1 Day Class (Toddlers ONLY) $115.00 monthly
KINDERGARTEN $390.00 monthly
Note: Non-refundable registration fee is due at the time of registration.
Toddler through Pre-K registration fee - $165.00
Kindergarten registration fee - $220.00
There is a 10% discount on tuition for additional children in the same family.
PLEASE √ THE PROGRAM DESIRED:
* Must be program age by September 30th
2 1/2 year old *children DO NOT have to be toilet trained
□ 5 day □ 4 day □ 3 day □ 2 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs) (Tues and Thurs)
Toddler (18 months by Sept. 30th)
*children DO NOT have to be toilet trained
CHOOSE YOUR DAYS
□ Monday □ Tuesday □ Wednesday □ Thursday □ Friday
□ 5 day □ 4 day □ 3 day □ 2 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs) (Tues and Thurs)
□ 5 day □ 4 day □ 3 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs)
□ 5 day (Mon thru Fri)
3 year old
*children MUST BE toilet trained
4 year Old *children MUST BE toilet trained
Kindergarten (5 by Sept. 30th)
U/Registration/Registration Form/2017
LONDON BRIDGE BAPTIST PRESCHOOL & KINDERGARTEN
REGISTRATION FORM
□ Returning Student □ New Student School Year: 2018-2019
Child's Full Name _____________________________________________________________________
Name child goes by DOB ___________________ Sex: □ M □ F
Address ________________________________________________________________________________
Main Phone ______________________________ Contact E-mail ________________________________
Parent Information □ Married □ Single □ Divorced □ Separated □Widowed Father' Name ____________________________ Address (if different) _________________________________
Occupation ___________________ Work # _________________________ Cell # _____________________
Mother's Name __________________________ Address (if different) _________________________________
Occupation ___________________ Work # _________________________ Cell # _____________________
Child Resides With (if not the Mother or Father) Name ___________________________________________
Relationship ___________________ Work # _________________________ Cell # _____________________
Emergency Contacts:
(Two local persons other than parents available for emergency pick up during school hours)
1. Name _________________________ Home # ____________Work # ____________Cell #
2. Name _________________________ Home # ____________Work # ____________Cell #
Persons NOT authorized to pick-up: Names and ages of siblings: Church you are currently attending:
Would you be interested in information about London Bridge Baptist Church? □ Yes □ No How did you hear about our program?
TODDLER: □ Mon □Tues □Wed □Thurs □Fri
Assigned Teacher: ______________________
3 YR OLD: □ 5 day □ 4 day □ 3 day □ 2 day
Assigned Teacher: __________________________
PRE-K: □ 5 day □ 4 day □ 3 day
Assigned Teacher: __________________________
KINDERGARTEN: Assigned Teacher: _______________
2 1/2 YR OLD: □ 5 day □ 4 day
□ 3 day □ 2 day
Assigned Teacher: _______________
************************************************************************************************* OFFICE USE ONLY
AUTHORIZATION FOR EMERGENCY TREATMENT OF MINOR CHILD
This document authorizes emergency medical treatment of the minor child (under 18 years of age) in the absence of parent(s) or legal
guardian(s). The original completed and notarized copy of this form shall be presented by (or on behalf of) the minor.
THE MINOR NAME (First, Last)
BIRTHDATE LAST FOUR OF SS NUMBER
PARENT/GUARDIAN
I / We the parent(s) or legal guardian(s) of the above named minor authorize emergency medical treatment
by affiliated physician(s) and staff personnel and the below hospital facility throughout the specified dates
and assume responsibility for all costs not covered by insurance policy.
PARENT(S) OR LEGAL GUARDIAN(S)
HOME PHONE CELL PHONE
ADDRESS
SIGNATURE
MINOR’S
HOSPITALIZATION
COVERAGE
HOSPITAL FACILITY:
Name of Hospital
or Closest
_____________________
INCLUSIVE DATES OF AUTHORIZATION (if dated)
FROM __________________
TO _________________
NAME OF INSURANCE COMPANY
POLICY NUMBER
ADDRESS OF INSURANCE COMPANY
NAME OF INSURED
RELATIONSHIP TO MINOR
ADDRESS
LAST FOUR OF SS NUMBER
MINOR’S
MEDICAL
INFORMATION
ALLERGIES OR SPECIAL CONDITIONS
EMERGENCY TREATMENT
NAME OF PHYSICIAN
ADDRESS
TELEPHONE
PLEASE SIGN IN THE PRESENCE OF A STAFF MEMBER AT THE TIME OF REGISTRATION
___________________________________________________________ __________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN DATE
___________________________________________________________ __________________________
WITNESS DATE
************************ OFFICE USE ONLY **************************
IDENTITY VERIFICATION
The 1998 General Assembly passed legislation which affects child day centers sponsored by religious institutions. This law is
intended to help identify missing children and requires the following:
Proof of the child's identity and age may include a certified copy of the child's birth certificate, birth certificate, notifica-
tion of birth (hospital, physician or midwife record), passport, copy of the placement agreement or other proof of the
child's identity from a child placing agency, record from a public school in Virginia, or certification by a principal or his de-
signee of a public school in the U.S. that a certified copy of the child's birth record was previously presented. While pro-
grams are not required to keep the proof of the child's identity, documentation of viewing this information must be main-
tained for each child. If the requested information is not received within seven business days of your child’s first day of
school, we are bound by law to notify the local law enforcement agency.
Birth Certificate Information For:________________________________________________
Birth Certificate Notification of Birth VA. Public School
(Hospital, physician, or midwife record) (Record)
Public School in U.S. Placement agreement or proof of child's Passport
(letter from Principal) identity from a child placing agency.
____________________________________________ has viewed the required information.
Place of Birth Birth Date Birth Certificate Number Date Issued
CONSENT FOR USE OF PHOTOGRAPHS
I hereby authorize and give full consent to London Bridge Baptist Preschool and Kindergarten to publish and
copyright all photographs in which my child appears while enrolled as a student in any and all programs of
London Bridge Baptist Preschool and Kindergarten. I further agree that LBBP may transfer or use these
photographs in preschool publications and advertising excluding social media websites and applications.
Additionally, I agree that use of a photograph or photographs does not constitute in any manner a waiver of
LBBP’s policies, program, or rules, nor does continued use constitute an agreement to continue the child’s
enrollment.
I am the parent and/or guardian of ____________________________________________. I hereby approve
the foregoing and consent to the use of photographs subject to the terms mentioned above. I affirm that I
have the legal right to issue such consent.
___________________________________________ _________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN DATE
1.
2.
School/Program School/Program
Address Address
City, State, Zip Code City, State, Zip Code
Dates of Attendance Dates of Attendance
PROOF OF PREVIOUS PROGRAMS
Please provide information on previous programs and schools your child has attended. This includes the name
of the program, school, and location, to assure proper identification of the program(s) or school(s).
My child has not attended any previous programs or schools.
My child has attended London Bridge Baptist Preschool the following school year(s):
1. _____ Year Old Program School Year __________
2. _____ Year Old Program School Year __________
3. _____ Year Old Program School Year __________
Other: My child has attended the following programs:
Consent for release of Contact Information
I do ___ do not___ want my phone number and /or my address to be released to
other classroom parents for the purpose of planning parties or other social events
outside of school.
_____________________ Signature of Parent or Legal Guardian
SCHOOL NOTIFICATIONS
We will send group text messages occasionally during the course of the school year to
keep you informed and updated with upcoming events and school closings.
London Bridge Baptist Preschool & Kindergarten
Financial Agreement
2018-2019
Child’s Name_______________________________
Please initial on the lines below indicating that you have read and understand each item.
Registration Fee
THE REGISTRATION FEE IS NON-REFUNDABLE.
The Registration Fee includes a materials fee as well as the fee for a LBBP class t-shirt. This fee is
due at the time you register and is required to officially enroll in the preschool.
Tuition Payments
Tuition is based on an annual rate. This rate is broken down into monthly payments.
Payments are due on the 15th of each month for the following month. Tuition for
September 2018 is due by August 15, 2018 or at the time of registration, if registration takes place
after August 15, 2018. Final tuition payments for the year will be due April 15, 2019. If tuition
payments are made after the 20th of the month, please include the $35.00 late fee. Payments can be
made by cash, check, or charge at the preschool. When registration is official, you will also be able
to make payments through the LBBP website. lbbp.londonbridge.org
Withdrawals
A two week written notice is required upon withdrawal from the program; otherwise the
tuition payments already made will not be reimbursed.
Delinquent Accounts
Tuition payments are due on the 15th of the month prior to the month you are paying for. Past due
accounts that have not been paid in full by the first of that month will result in student dismissal from
the classroom. If then, the account is not brought current by the 15th of that month, it will result in
automatic withdrawal from the preschool. To re-enroll your student, you will need to bring your
account current and pay an additional registration fee.
_______________________________________ ________________
Signature of Parent or Legal Guardian Date
London Bridge Baptist Preschool & Kindergarten EMERGENCY INFORMATION CARD
PERSONS AUTHORIZED TO PICK UP CHILD
________________________ ________________________ _______________________
________________________ ________________________ _______________________
EMERGENCY INFORMATION
Two Local Emergency Contact Names and Numbers other than Parents:
1. ____________________________ Home# ( )______________ Cell#( )_____________
Relationship To Child_____________ Work# ( )______________
2. ____________________________ Home# ( )______________ Cell#( )_____________
Relationship To Child______________ Work# ( )______________
Male Female
Child’s Name _______________________________________________
Date of Birth _________________________
Mother’s Name ____________________ Father’s Name __________________
Mother’s Work# ____________________ Father’s Work# __________________
Mother’s Cell# ____________________ Father’s Cell# __________________
Main Contact (if not the Mother or Father):
Name: ___________________________ Relationship ______________Phone # ____________
*OFFICE USE ONLY* Room # _____________ Program _____________ # of Days _____________ Teacher ______________
Allergies: __________________________________________________________________ Emergency Treatment: _______________________________________________________
*If your child needs medication administered during school hours, please request a Written Medication Consent Form from the Welcome Center Desk.
School Year: 2018-2019
PERSONS NOT AUTHORIZED TO PICK UP CHILD ______________________________________________
Appropriate paperwork such as custody papers shall be attached if a parent is not allowed to pick up a child.
NOTE: Section 22.1-4.3 of the Code of Virginia states that unless a court order has been issued to the contrary, the noncusto-
dial parent of a student enrolled in a public school or day care center must be included, upon the request of such noncusto-
dial parent, as an emergency contact for events occurring during school or day care activities.
Sex