GCPC Fall Parents Day Out Enrollment

Precious Parents,

We are excited and looking forward to the next school year. We look forward to the blessed opportunity to walk alongside your family and offer a Christian environment to love and nurture your child.

We are now opening pre-registration for CURRENT students for the upcoming school year. If you are a new student, please contact director.

Program Rates:
Registration fee: $125 per child
Tuition: $225 per month (August through May)

Hours of Operation:
Tuesdays & Thursdays from 9:00am - 2:00pm
Goodlettsville Parents Day Out Program will inform parents of any holidays or closings, including inclement weather, illness, etc.

If you have any questions, please contact me:
Church phone: 615-859-5888
My email: gchurchcece@gmail.com.

We are excited and look forward to another blessed and fun school year!

Blessings,
Cece McDonald
Goodlettsville Church
Early Childhood Director

"Children are a gift from the Lord; they are a reward from him." - Psalm 127:3

Child's information

First Name

Last Name

Name they preferred to be called

Gender

Birthdate

Child's Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Has your child been in group care before? if yes, please describe.

Do you have any concerns about how your child will adjust to our program?

Is there anything special we should know about your child or family? (e.g., recent move, change in family size)

List any existing medical conditions, medication, and/or special attention your child may require.

Allergies

Pediatrician's Name

Pediatrician's Phone Number

Pediatrician's Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Hospital Preference

Parent's Information:

Dad / Guardian

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Cell

Home

Work

Email

Occupation

Employer

Work Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Custodial Parent?

Yes

No

Mom / Guardian

Marital Status

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Cell

Home

Work

Email

Occupation

Employer

Work Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Custodial Parent?

Yes

No

Marital Status

Routines:

Eating

As a rule, is your child's appetite

Excellent

Good

Fair

Poor

Can your child feed him/herself completely?

How do you handle refusal to eat?

List any food eliminated by a doctor:

List favorite foods:

List foods especially disliked:

Any feeding problems?

Sleeping

Approximate time your child goes to bed?

Wakes up:

Naps from: ___ to ___

Any sleep problems?

Any special ways of helping him/her get to sleep?

Release Authorization Form

The individuals listed below are authorized to pick up my child or to assume responsibility for my child in case of an emergency, accident, or illness. If none of the people listed are available, I give my permission to Goodlettsville Church Parent's Day Out Program Staff to make a plan for the care of my child.

Parent's Full Signature

Date

Adults authorized to pick up your child, other than parents:

Name

Relationship to Child

Phone Number

Address

Name

Relationship to Child

Phone Number

Address

Name

Relationship to Child

Phone Number

Address

If additional adults are needed for pick up authorization, please contact me for an additional form!

Authorization for Direct Payment Draft via Automated Clearing House (ACH Debit)

Direct payment via ACH is the transfer of funds from a consumer account for the purpose of making a payment. Payments are to be made on the first Tuesday of every month using the ACH Direct Deposit or check.

I (we) authorize GOODLETTSVILLE CHURCH PDO to electronically debit my (our) account, and, if necessary, electronically credit my (our) account to correct erroneous debits as follows:

Select one:

Checking account

Savings account

At the depository financial institution named below. I (we) agree that the ACH transactions I (we) authorize comply with all applicable law.

Depository Financial Institution Name:

Routing number:

Account Number:

Amount of Debit(s) Authorized:

Date and/or frequency of debit(s):

I (we) understand that this authorization will remain in full force and effect until I (we) notify GOODLETTSVILLE CHURCH PDO in writing that I (we) wish to revoke this authorization. I (we) understand that GOODLETTSVILLE CHURCH PDO requires at least of 30 days prior notice in order to process this request and cancel this authorization.

First Name

Last Name

Full Signature

Date

Register Today!!!

GCPC Fall Parents Day Out Enrollment

Child's information

Parent's Information:

Routines:

Release Authorization Form

Authorization for Direct Payment Draft via Automated Clearing House (ACH Debit)

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