Preschool Summer Camp
Wednesday Night Refuel
How many days?
2 Day Class
3 Day Class
5 Day Class
Parents' Marital Status
The following people have permission to pick up my child:
Is English the primary language in your child's home?
Does your child understand and speak English at his/her age level?
If your child has allergies, is an Epi Pen necessary?
Please list any medications that your child is taking. An action plan from your child's doctor, with a picture of your child, is required to store and administer any medication (inhalers, Epi Pen, Benadryl, etc.)
Is your child currently receiving medical/ therapeutic/ development services at this time? If yes, please list and submit info regarding these services
Does your child have other Special Needs we should be aware of? If yes, please list
Does your child have any physical restrictions? If yes, please explain
What is your child's previous preschool or daycare experience?
What are your expectations for your child at Potter's Hand Preschool?
What would you like to share about your child so that we can know him/her better? (ie, likes, dislikes, fears, etc.)
Registrations Fee: The registration fee is $100 for each student and is non-refundable after the child is placed. I understand that the only time my registration fee is refundable is if my family moves from Wake County before preschool begins.
Immunizations Requirement: All children attending PHPS must be up to date on immunizations by the first day of school. A copy of your child's immunizations must be turned in with the first tuition to ensure enrollment at Potter's Hand Preschool. Please understand we do not currently accept waivers of exemption for any reason.
Tuition: Tuition is due at the first of the month the beginning of September and each consecutive month of the school calendar
Withdrawal: 30 days notice is required prior to withdrawing a child. Full and/or prorated tuition through notice will be due. Written notice needs to be turned into director.
Potty Training: I understand that my child must be completely potty trained, which means wearing underwear and not pull-ups, and be able to take care of his/her own bathroom needs to be in the three and four year old classes.
Photographs: I understand PHPS may post my child's photograph on our website and PHPS FaceBook page.
Medical Emergencies: In the event of an emergency, I give PHPS full consent to secure medical attention and treatment for my child should I not be able to be reached. I agree to be financially responsible for any costs incurred.
My signature indicates that I understand and agree to the policies and expectations of PHPS and understand that failure to do so and/or falsification of the information on this enrollment form is cause for dismissal.
Pay Registration Fee