Enrollment

Enrollment Form

St. Luke Early Childhood Center 2022-2023 School Year Application

- Step 1 of 9

Best Email for All School/Classroom Communications: One required *

Child's Name *

First

Last

Nick Name (if any)

Gender

Male
Female

Date of Birth //

Application Type *

Re-Enrollment
New Student

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Family Information

Father's Name

First

Last

Father Email

Father Cell Phone

Father Business Phone

Father's Place of Employment

Home Phone

Father's Address

Address Line 1

Address Line 2

City

State

Zip Code

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Mother's Information

Mother's Name

First

Last

Mother's Email

Mother's Cell Phone

Mother's Place of Employment

Mother and Father have different addresses?

Mother's Address (different from father)

Address Line 1

Address Line 2

City

State

Zip Code

Mother's Home Phone

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Family and Child Background

Faith

Catholic
Non-Catholic

Parish where registered

Denomination

Non-Catholic denomination

Primary language spoken in the home.

Second language spoken in the home (if any)

Cultural background

If your family has any cultural background information to share that would help us better serve you and your family, please note that information here

Prior childcare programs?

Has your child ever participated in a childcare program before?

Prior childcare facility?

Where did they previously attend?

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Does your child have any allergies?

Please list the allergies:

Is medication required?

Do you have a doctor's treatment plan for the allergies?

Please upload the doctor's treatment plan.

Click or drag files to this area to upload. You can upload up to 3 files.

PDF or Word files accepted

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Special needs

Has your child ever been evaluated and/or recommended for special needs?

Special needs description

Please explain what special needs exists so that we may try to accommodate them.

Special needs evaluation

Click or drag a file to this area to upload.

If you have an evaluation please submit it here.

Special needs prior programs:

Has your child ever participated in a special needs program?

Prior special needs program

Please explain the program and services provided to accommodate the need.

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Is there a court-ordered custody or Parenting Plan?

Name of Primary Residential Parent

First

Last

Name of Secondary Residential Parent

First

Last

Guardian (if other than parents)

First

Last

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Age of your child September 1 of Fall Semester?

Programs are determined by age of the child as of Sept. 1 of the Fall Semester.

Two-Year Old Programs

9 - Noon (Tues and Thurs) two half days - $ 265.00
9 - Noon (Mon, Wed, Fri) three half days - $ 350.00
9 - Noon (M-F) five half days - $ 440.00

Child must be 2 on or before September 1 of Fall Semester.
Monthly tuition is due on the first day of each month from July through April.

Three-Year Old Programs

9 - Noon (Mon, Wed, Fri) three half days - $ 350.00
9 - Noon (M-F) five half days - $ 440.00

Child must be 3 on or before September 1 of Fall Semester and be potty trained.
Monthly tuition is due on the first day of each month from July through April.

Four-Year Old Programs

9 - Noon (M-F) five half days - $ 440.00
9 - 2 PM (M-F) five days - $ 572.00

Child must be 4 on or before September 1 of Fall Semester.
Monthly tuition is due on the first day of each month from July through April.

VPK Eligibility

The Voluntary Prekindergarten Program (VPK) is a free program for all 4 and 5 year-olds who reside in Florida and are 4 years old on or before September 1 of each year. Application link.

VPK Certificate of Eligibility

Date on which you applied for VPK Certificate of Eligibility (if any).

Lunch Bunch (noon-2PM)

3 days/week Lunch Bunch - $ 120.00

Per month, prepaid reserved space.
Sorry, we cannot offer refunds for absences.

Lunch Bunch (noon-2PM)

5 days/week Lunch Bunch - $ 200.00

Per month, prepaid reserved space.
Sorry, we cannot offer refunds for absences.

VPK Extended Hours (Noon to 2 PM)

VPK Extended Hours (M-F) - $ 340.00

Per month. Free VPK finishes at noon. This option extends play to 2 PM. $3,400 if paid annually.

ABC Club (early and aftercare)

Add on to 9-2 M-F students - $ 288.00

8-9 am early dropoff and noon to 5:30 pm extended care.

ABC Club (early and aftercare)

Add on to 9-12 MWF students - $ 300.00

8-9 am early dropoff and noon to 5:30 pm extended care.

ABC Club (early and aftercare)

Add on to 9-12 M-F students - $ 450.00

8-9 am early dropoff and noon to 5:30 pm extended care.

Total per month

$ 0.00

Anticipated total costs per month during school-year.

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Extended Day Hours (Application fee of $130 applies to VPK students using the extended care program)

7:30 am to 9 am
12 pm to 6 pm
Lunch Bunch: 12 pm to 2 pm

Extended Day hours are available as listed below. Please indicate if you would be interested in extended day hours:

Check extended days needed

Mon
Tues
Wed
Thurs
Fri

Before and aftercare programs are dependent on sufficient participation

We will make available a class list with Parent emails for Birthdays and Room Parents (Sign out sheet is in the Center’s Office and not to be used for soliciting purposes).

You have our permission to share our email address

How did you hear about St. Luke ECC?

Website
Early Learning Coalition
KMO Program
St. Luke Church
Referred by a friend
Other

Other / Referral to Program:

Father/Stepfather/Guardian Signature

I attest that all information included on this application form is true and accurate. I understand that any willful omission or untrue statement may warrant the non-acceptance or dismissal or my/our child from the school program at St. Luke Early Childhood Center.

Mother/Stepmother/Guardian Signature

*Person/Persons responsible for financial obligations

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