Today's Date

MM

DD

YYYY

Child's Name *

First Name

Last Name

Childs Birth Date *

MM

DD

YYYY

My Child will be 3 Years Old by September 1 and is Potty Trained. *

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Phone

(###)

###

####

For those choosing the 2 or 3 day programs, please indicate which days you need coverage

Monday

Tuesday

Wednesday

Thursday

Friday

ADDITIONAL Early AM Care

A light Breakfast will be served. This option is for those who must drop off their children before the preschool hours (6:30am.) An additional fee of $7 per day is charged

Monday

Tuesday

Wednesday

Thursday

Friday

ADDITIONAL Afternoon Care

A light snack will be served. This option is for those who must drop off their children after the preschool hours (3:30pm.) An additional fee of $7 per day is charged.

Monday

Tuesday

Wednesday

Thursday

Friday

Permission Requirement

Preschool families using Before and After care understand that the preschoolers are combined with the elementary age students during before and after care. I give my permission for my child to be combined with the elementary age children.

Yes

Billing Information *

BrightWheel billing for PRESCHOOL differs from BEFORE AND AFTER CARE. Families using the before and after care options will receive two separate invoices in BrightWheel (r).

Acknowledged

BrightWheel Notification *

Pathfinder Kids uses BrightWheel (r) to collect and store data and forms; record attendance; and bill tuition. I understand it is my responsibility to download this app and connect to this school.

Acknowledged

Program Change *

Program and billing changes may be done once for free. Program and Billing changes will be charged a $25 processing fee, thereafter.

Acknowledged

Late Fee *

I acknowledge that a late fee of $25 will be charged for balances five days past due.

Acknowledged

By selecting, "Yes" I agree that a digital copy of the Pathfinder Kid's Parent Guide was received https://docs.google.com/document/d/1K_NXpX1eHb0IVETueIn0aVA88IGKzVCB1iml162JT6w/edit?usp=sharing *

Yes

Prescription Permission *

I acknowledge that any prescription medication my child is prescribed will be labeled properly if brought to the center. I agree to complete a separate medication form before the medication can be administered.

Yes

Over The Counter Medications *

I give permission for Pathfinder Kids staff to administer topical non-prescription medication including, but not limited to petroleum jelly, triple antibiotic, anti-itch, sunscreen, and insect repellent .

Acknowledged

Photography *

I understand that upon enrolling my child into the Pathfinder Kids program, their photos may be taken and used for marketing, informational, and promotional materials.

Yes

No

Age and Potty Training *

My child will be three by September 1st. My child is potty trained.

Yes

Discipline *

I have read, acknowledge, and understand the discipline procedures that are outlined within this handbook.

Yes

Portage Central Elementary Families

Portage Central Elementary Families Only: I give permission for my child to walk to/from Portage Central Elementary school with Pathfinder Kids staff and trained volunteers.

Yes

No

Lake Center Elementary Families

Lake Center Elementary Families Only: I give permission for my child to board the portage Public Schools bus. I have contacted the PPS transportation to let them know they will ride the bus to/from Pathfinder Kids.

Yes

No

Certification

Checking the form below is considered my digital signature and will be used to establish this contract with Pathfinder Kids. I declare that I acknowledge and agree to the Pathfinder Kids parent handbook. My child and I will follow the policies and procedures contained therein while my child is in attendance at Pathfinder Kids.

Yes