Teva Tots Registration

How many children would you like to register?*

Child's Full Name*

First Name Last Name

What is your child's nickname?

Child's Date of Birth*

Month Day Year

Child's Gender*

GirlBoy

Previous School or Day Care Center

Does your child have any allergies and/or medical problems?*

YesNo

Please Explain

Are there any conditions or behavior that require special attention, medication or a special diet?*

YesNo

Please Explain

Has your child ever been hospitalized or had a serious illness?*

YesNo

Please Explain

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past*

YesNo

Please Explain

Child's Full Name*

First Name Last Name

What is your child's nickname?

Child's Date of Birth*

Month Day Year

Child's Gender*

GirlBoy

Previous School or Day Care Center

Does your child have any allergies and/or medical problems?*

YesNo

Please Explain*

Are there any conditions or behavior that require special attention, medication or a special diet?*

YesNo

Please Explain*

Has your child ever been hospitalized or had a serious illness?*

YesNo

Please Explain*

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past*

YesNo

Please Explain*

Child's Full Name*

First Name Last Name

What is your child's nickname?

Child's Date of Birth*

Month Day Year

Child's Gender*

GirlBoy

Previous School or Day Care Center

Does your child have any allergies and/or medical problems?*

YesNo

Please Explain*

Are there any conditions or behavior that require special attention, medication or a special diet?*

YesNo

Please Explain*

Has your child ever been hospitalized or had a serious illness?*

YesNo

Please Explain*

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past*

YesNo

Please Explain*

Mother's Full Name*

First Name Last Name

Mother's Cell Number*

Area Code Phone Number

Mother's E-mail*

Mother's Business/Work*

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Full Name*

First Name Last Name

Father's Cell Number*

Area Code Phone Number

Father's E-mail*

Father's Business/Work*

Address is Different From Above*

YesNo

Father's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status of Parents*

MarriedDivorcedOther

Emergency Contact 1's Name*

First Name Last Name

Emergency Contact 1's Phone Number*

Area Code Phone Number

Emergency Contact 1's Relationship to Child*

Emergency Contact 2's Name*

First Name Last Name

Emergency Contact 2's Phone Number*

Area Code Phone Number

Emergency Contact 2's Relationship to Child*

Doctor Name*

First Name Last Name

Doctor's Office Phone*

Area Code Phone Number

Doctor's Office Address*

Parents Signature*

Name

Relationship to child/ren

Hours of Operation Agreement*

I Agree

Permission to Photograph Agreement*

I Agree

Food Policy Agreement*

I Agree

Physical Activity Agreement*

I Agree

Tuition Commitment & Withdrawal Policy

When you enroll your child, we reserve a dedicated spot for your family and often turn away other applicants.

By enrolling, you are reserving a spot for your child. If you withdraw within 30 days of your scheduled start date or at any time after attendance begins, one month’s tuition will be charged.

We understand that plans can change and are always happy to communicate. This policy helps ensure stability for our program, staff, and families.

Tuition Commitment & Withdrawal Policy Agreement*

I understand and agree to the Tuition Commitment & Withdrawal Policy, including the one-month tuition charge if I withdraw within 30 days of my child’s start date or after attendance begins.

Parent Initials*

Parent Handbook Agreement*

I Agree

View Parent Handbook

Immunization Records Agreement*

I Agree

I have read all of the above information and I understand and consent to all the aforementioned.*

Parent’s Signature

Comments/Notes

Tuition Information

Tuition:
$1,190 per month, per child (includes daily lunches and snacks)

Registration fee:
A $100 non-refundable deposit is due at the time of registration per child

Payment Methods
Families may choose from the following payment options:

Pay tuition in full
Payment may be made by ACH, check, or credit card.
A 3% processing fee applies to credit card payments; no fee applies to ACH or check.
Pay monthly by ACH or check
No additional processing fees apply.
Pay monthly by credit card
A 3% processing fee will be added to all credit card payments.

Tuition Policy:

If paying monthly by credit card, your card on file will be automatically charged on the 1st of each month.
If paying monthly by ACH, payments will be processed automatically on the 1st of each month through a payment plan made via QuickBooks.
A one month penalty will be charged for any child withdrawn within one month before the start of the school year or at any time during the school year. Please see above Withdrawal Policy for more information.
A $35 fee will be assessed for returned checks.
There is no tuition adjustment or credit given for holidays, family vacations or illness.

Please choose from the following 4 payment methods:*

Pay the entire tuition amount in fullPay tuition on a monthly basis by credit card (A 3% processing fee will be applied)Pay tuition on a monthly basis by ACH ( No additional fee)Pay tuition on a monthly basis by submitting post-dated checks ( No additional fee)

Full Tuition Payment Agreement

I agree to have the credit card provided below charged the full annual tuition amount by August 1, 2026.

Charge my full tuition payment on the following date

Monthly Tuition Credit Card Payment Agreement*

I agree to have the credit card provided below charged the monthly tuition amount on the 1st of each month, beginning August 1, 2026 through June 1, 2027. I understand that a 3% credit card processing fee will be added to each monthly tuition charge.

Monthly Tuition ACH Payment Agreement*

I agree to enroll in the monthly ACH tuition payment plan. An ACH authorization request will be sent by the preschool office via QuickBooks and must be completed to activate the payment plan. Monthly tuition payments will be automatically withdrawn on the 1st of each month from August 1, 2026 through June 1, 2027.

Monthly Tuition Check Payment Agreement*

I agree to drop off 11 post dated checks for preschool tuition for the year by August 1, 2026.

Please select Extended Care you are interested in

8:00am - 9:00am - $200 per month3:00pm - 4:00pm - $200 per month3:00pm - 5:00pm - $400 per month

Registration Fee*

$100.00

Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Expiration Month	Expiration Year

CHILD INFORMATION

Child One

Medical Information

Child Two

Medical Information

Child Three

Medical Information

PARENTS INFO

MEDICAL/AUTHORIZATION

Emergency/Alternate Contacts

Family Doctor

Emergency Care Authorization

Authorization for Pickup

ADDITIONAL INFORMATION

Hours of Operation

Permission to Photograph

Food Policy

Physical Activity

Parent Handbook

Immunization Records

PAYMENT INFORMATION

Extended Care

Registration Fee

Community

Children & Teens

Young Adults

Women

Adult Learning

Guests & Tourists