2018/2019

School Programs

10:00 a.m. - 2:00 p.m.

2460 Potters Road

Virginia Beach, VA 23454

757-486-7907

Fax# 757-486-3178

www.lbbp.londonbridge.org

5 Day Class $340.00 monthly

4 Day Class $295.00 monthly

3 Day Class $270.00 monthly

2 Day Class $225.00 monthly

1 Day Class (Toddlers ONLY) $115.00 monthly

KINDERGARTEN $390.00 monthly

Note: Non-refundable registration fee is due at the time of registration.

Toddler through Pre-K registration fee - $165.00

Kindergarten registration fee - $220.00

There is a 10% discount on tuition for additional children in the same family.

PLEASE √ THE PROGRAM DESIRED:

* Must be program age by September 30th

2 1/2 year old *children DO NOT have to be toilet trained

□ 5 day □ 4 day □ 3 day □ 2 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs) (Tues and Thurs)

Toddler (18 months by Sept. 30th)

*children DO NOT have to be toilet trained

CHOOSE YOUR DAYS

□ Monday □ Tuesday □ Wednesday □ Thursday □ Friday

□ 5 day □ 4 day □ 3 day □ 2 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs) (Tues and Thurs)

□ 5 day □ 4 day □ 3 day (Mon thru Fri) (Mon thru Thurs) (Tues-Wed-Thurs)

□ 5 day (Mon thru Fri)

3 year old

*children MUST BE toilet trained

4 year Old *children MUST BE toilet trained

Kindergarten (5 by Sept. 30th)

U/Registration/Registration Form/2017

LONDON BRIDGE BAPTIST PRESCHOOL & KINDERGARTEN

REGISTRATION FORM

□ Returning Student □ New Student School Year: 2018-2019

Child's Full Name _____________________________________________________________________

Name child goes by DOB ___________________ Sex: □ M □ F

Address ________________________________________________________________________________

Main Phone ______________________________ Contact E-mail ________________________________

Parent Information □ Married □ Single □ Divorced □ Separated □Widowed Father' Name ____________________________ Address (if different) _________________________________

Occupation ___________________ Work # _________________________ Cell # _____________________

Mother's Name __________________________ Address (if different) _________________________________

Occupation ___________________ Work # _________________________ Cell # _____________________

Child Resides With (if not the Mother or Father) Name ___________________________________________

Relationship ___________________ Work # _________________________ Cell # _____________________

Emergency Contacts:

(Two local persons other than parents available for emergency pick up during school hours)

1. Name _________________________ Home # ____________Work # ____________Cell #

2. Name _________________________ Home # ____________Work # ____________Cell #

Persons NOT authorized to pick-up: Names and ages of siblings: Church you are currently attending:

Would you be interested in information about London Bridge Baptist Church? □ Yes □ No How did you hear about our program?

TODDLER: □ Mon □Tues □Wed □Thurs □Fri

Assigned Teacher: ______________________

3 YR OLD: □ 5 day □ 4 day □ 3 day □ 2 day

Assigned Teacher: __________________________

PRE-K: □ 5 day □ 4 day □ 3 day

Assigned Teacher: __________________________

KINDERGARTEN: Assigned Teacher: _______________

2 1/2 YR OLD: □ 5 day □ 4 day

□ 3 day □ 2 day

Assigned Teacher: _______________

************************************************************************************************* OFFICE USE ONLY

AUTHORIZATION FOR EMERGENCY TREATMENT OF MINOR CHILD

This document authorizes emergency medical treatment of the minor child (under 18 years of age) in the absence of parent(s) or legal

guardian(s). The original completed and notarized copy of this form shall be presented by (or on behalf of) the minor.

THE MINOR NAME (First, Last)

BIRTHDATE LAST FOUR OF SS NUMBER

PARENT/GUARDIAN

I / We the parent(s) or legal guardian(s) of the above named minor authorize emergency medical treatment

by affiliated physician(s) and staff personnel and the below hospital facility throughout the specified dates

and assume responsibility for all costs not covered by insurance policy.

PARENT(S) OR LEGAL GUARDIAN(S)

HOME PHONE CELL PHONE

ADDRESS

SIGNATURE

MINOR’S

HOSPITALIZATION

COVERAGE

HOSPITAL FACILITY:

Name of Hospital

or Closest

_____________________

INCLUSIVE DATES OF AUTHORIZATION (if dated)

FROM __________________

TO _________________

NAME OF INSURANCE COMPANY

POLICY NUMBER

ADDRESS OF INSURANCE COMPANY

NAME OF INSURED

RELATIONSHIP TO MINOR

ADDRESS

LAST FOUR OF SS NUMBER

MINOR’S

MEDICAL

INFORMATION

ALLERGIES OR SPECIAL CONDITIONS

EMERGENCY TREATMENT

NAME OF PHYSICIAN

ADDRESS

TELEPHONE

PLEASE SIGN IN THE PRESENCE OF A STAFF MEMBER AT THE TIME OF REGISTRATION

___________________________________________________________ __________________________

SIGNATURE OF PARENT OR LEGAL GUARDIAN DATE

___________________________________________________________ __________________________

WITNESS DATE

************************ OFFICE USE ONLY **************************

IDENTITY VERIFICATION

The 1998 General Assembly passed legislation which affects child day centers sponsored by religious institutions. This law is

intended to help identify missing children and requires the following:

Proof of the child's identity and age may include a certified copy of the child's birth certificate, birth certificate, notifica-

tion of birth (hospital, physician or midwife record), passport, copy of the placement agreement or other proof of the

child's identity from a child placing agency, record from a public school in Virginia, or certification by a principal or his de-

signee of a public school in the U.S. that a certified copy of the child's birth record was previously presented. While pro-

grams are not required to keep the proof of the child's identity, documentation of viewing this information must be main-

tained for each child. If the requested information is not received within seven business days of your child’s first day of

school, we are bound by law to notify the local law enforcement agency.

Birth Certificate Information For:________________________________________________

Birth Certificate Notification of Birth VA. Public School

(Hospital, physician, or midwife record) (Record)

Public School in U.S. Placement agreement or proof of child's Passport

(letter from Principal) identity from a child placing agency.

____________________________________________ has viewed the required information.

Place of Birth Birth Date Birth Certificate Number Date Issued

CONSENT FOR USE OF PHOTOGRAPHS

I hereby authorize and give full consent to London Bridge Baptist Preschool and Kindergarten to publish and

copyright all photographs in which my child appears while enrolled as a student in any and all programs of

London Bridge Baptist Preschool and Kindergarten. I further agree that LBBP may transfer or use these

photographs in preschool publications and advertising excluding social media websites and applications.

Additionally, I agree that use of a photograph or photographs does not constitute in any manner a waiver of

LBBP’s policies, program, or rules, nor does continued use constitute an agreement to continue the child’s

enrollment.

I am the parent and/or guardian of ____________________________________________. I hereby approve

the foregoing and consent to the use of photographs subject to the terms mentioned above. I affirm that I

have the legal right to issue such consent.

___________________________________________ _________________________

SIGNATURE OF PARENT OR LEGAL GUARDIAN DATE

1.

2.

School/Program School/Program

Address Address

City, State, Zip Code City, State, Zip Code

Dates of Attendance Dates of Attendance

PROOF OF PREVIOUS PROGRAMS

Please provide information on previous programs and schools your child has attended. This includes the name

of the program, school, and location, to assure proper identification of the program(s) or school(s).

My child has not attended any previous programs or schools.

My child has attended London Bridge Baptist Preschool the following school year(s):

1. _____ Year Old Program School Year __________

2. _____ Year Old Program School Year __________

3. _____ Year Old Program School Year __________

Other: My child has attended the following programs:

Consent for release of Contact Information

I do ___ do not___ want my phone number and /or my address to be released to

other classroom parents for the purpose of planning parties or other social events

outside of school.

_____________________ Signature of Parent or Legal Guardian

SCHOOL NOTIFICATIONS

We will send group text messages occasionally during the course of the school year to

keep you informed and updated with upcoming events and school closings.

London Bridge Baptist Preschool & Kindergarten

Financial Agreement

2018-2019

Child’s Name_______________________________

Please initial on the lines below indicating that you have read and understand each item.

Registration Fee

THE REGISTRATION FEE IS NON-REFUNDABLE.

The Registration Fee includes a materials fee as well as the fee for a LBBP class t-shirt. This fee is

due at the time you register and is required to officially enroll in the preschool.

Tuition Payments

Tuition is based on an annual rate. This rate is broken down into monthly payments.

Payments are due on the 15th of each month for the following month. Tuition for

September 2018 is due by August 15, 2018 or at the time of registration, if registration takes place

after August 15, 2018. Final tuition payments for the year will be due April 15, 2019. If tuition

payments are made after the 20th of the month, please include the $35.00 late fee. Payments can be

made by cash, check, or charge at the preschool. When registration is official, you will also be able

to make payments through the LBBP website. lbbp.londonbridge.org

Withdrawals

A two week written notice is required upon withdrawal from the program; otherwise the

tuition payments already made will not be reimbursed.

Delinquent Accounts

Tuition payments are due on the 15th of the month prior to the month you are paying for. Past due

accounts that have not been paid in full by the first of that month will result in student dismissal from

the classroom. If then, the account is not brought current by the 15th of that month, it will result in

automatic withdrawal from the preschool. To re-enroll your student, you will need to bring your

account current and pay an additional registration fee.

_______________________________________ ________________

Signature of Parent or Legal Guardian Date

London Bridge Baptist Preschool & Kindergarten EMERGENCY INFORMATION CARD

PERSONS AUTHORIZED TO PICK UP CHILD

________________________ ________________________ _______________________

________________________ ________________________ _______________________

EMERGENCY INFORMATION

Two Local Emergency Contact Names and Numbers other than Parents:

1. ____________________________ Home# ( )______________ Cell#( )_____________

Relationship To Child_____________ Work# ( )______________

2. ____________________________ Home# ( )______________ Cell#( )_____________

Relationship To Child______________ Work# ( )______________

Male Female

Child’s Name _______________________________________________

Date of Birth _________________________

Mother’s Name ____________________ Father’s Name __________________

Mother’s Work# ____________________ Father’s Work# __________________

Mother’s Cell# ____________________ Father’s Cell# __________________

Main Contact (if not the Mother or Father):

Name: ___________________________ Relationship ______________Phone # ____________

*OFFICE USE ONLY* Room # _____________ Program _____________ # of Days _____________ Teacher ______________

Allergies: __________________________________________________________________ Emergency Treatment: _______________________________________________________

*If your child needs medication administered during school hours, please request a Written Medication Consent Form from the Welcome Center Desk.

School Year: 2018-2019

PERSONS NOT AUTHORIZED TO PICK UP CHILD ______________________________________________

Appropriate paperwork such as custody papers shall be attached if a parent is not allowed to pick up a child.

NOTE: Section 22.1-4.3 of the Code of Virginia states that unless a court order has been issued to the contrary, the noncusto-

dial parent of a student enrolled in a public school or day care center must be included, upon the request of such noncusto-

dial parent, as an emergency contact for events occurring during school or day care activities.

Sex