Child's Full Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Contact Cell # *

(###)

###

####

Date of Birth *

MM

DD

YYYY

*

Male

Female

Father / Guardian's Name

First Name

Last Name

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Mother / Guardian’s Name

First Name

Last Name

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Child lives with

Father

Mother

Both

Please select one:

Registered Holy Trinity Parishioner

Other Religious Affiliation

Registered Catholic at another parish (which one?)

My child has a medical condition and/or allergy *

Yes

No

If YES, does the medical condition and/or allergy require medication and a physician's attention?

Yes

No

Is your child receiving services from Babies Can't Wait or any private therapist for speech, OT, or behavior? *

Yes

No

BY CHECKING THESE BOXES YOU ARE IN AGREEMENT WITH THE FOLLOWING POLICIES *

I understand than an up-to-date, completed Immunization form #3231 must be submitted by 1st day of school. Also, I am aware that the Archdiocese of Atlanta does not recognize an exemption based upon matter of conscience or religious objection. Therefore, I cannot use a religious exemption for my child.

I understand that my child must be a confident walker and a non-morning napper to enroll in this class. My child will not be able to stay in the program if these two thing are not met.

I understand that some children are not ready for a structured school environment. If my child has trouble adjusting emotionally or socially, he may have to be withdrawn from the PDO program. A conference with be held to discuss my child’s individual situation, possible strategies and timeline for improvement. Continuation in our program is the desired outcome but safety and all PDO families will be considered. A final decision will be at the discretion of the director.

I understand that a non-refundable $75 registration fee is due to reserve a spot.

I understand that is an annual tuition commitment for approximately 30 weeks. $390 per school year, payment due by Friday, Sept 5th, 2025. Or $195 by Friday, Sept 5th, 2025 and $195 Friday, Jan 5th, 2026. I understand that this is a contract for the school year and that tuition is due for my child even if he/she is sick, holiday breaks, severe weather days or you chose to take an extended vacation.

I understand that if my tuition is late I will be charged a $35 late fee. Continual late payment may result in dismissal of my child from the Parent Day Out program.

I understand that our program starts at 9am. Our doors open at 8:55am. All children should be dropped off by 9:10am. Our program ends at 12pm sharp. We understand if you are late a few times but continual tardiness causes problems with daily classroom structure or teachers finishing their end of the day routine and leaving by 12:30pm. A late fee will be charged if continued pickup tardiness occurs.

Registration will be taken on a first come/first served basis. Payment will not be refundable. Online payment is preferred and available on our parish website under 'Donate', www.holytrinityptc.org

Please select from:

Monday

Wednesday

Thursday