Enrollment And Tuition Form

Please Select Form Type*
Hidden
Today's Date
MM slash DD slash YYYY
Child Start Date*
MM slash DD slash YYYY
How Many Children Will You Be Enrolling?*
Base Product $0*
Total Registration Fee ($25 per child)
Price: $0.00
Select Your School District*
- Hillside
- Irvington
Home Address*
Street Address Address Line 2 City State ZIP Code
Parent or Custodian 1 Name*
First Last
Phone*
Employer Name
Employer Phone
Business Hours
Employer Address
Street Address Address Line 2 City State ZIP Code
Parent or Custodian 2 Name
First Last
Phone
Employer Name
Employer Phone
Business Hours
Employer Address
Street Address Address Line 2 City State ZIP Code
CHILD 1
Child’s Name*
First Last
DOB*
MM slash DD slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs*
CHILD 2
Child’s Name*
First Last
DOB*
DD slash MM slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs**
CHILD 3
Child’s Name*
First Last
DOB*
MM slash DD slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs*
CHILD 4
Child’s Name
First Last
DOB*
MM slash DD slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs*
CHILD 5
Child’s Name*
First Last
DOB*
MM slash DD slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs*
CHILD 6
Child’s Name*
First Last
DOB*
MM slash DD slash YYYY
Which Hillside School Will This Child Attend?*
- 143 Coe Ave. (A.P. Morris Early Childhood Center)
- 614 Tillman St. (Deanna Taylor Academy)
- 1261 Liberty Ave. (Hurden Looker Elementary)
- 1530 Leslie St. (Ola Edwards Community School)
Which Irvington School Will This Child Attend?*
- 97 Augusta St. (Augusta Preschool Academy)
- 602 Grove St. (Grove Street School)
Grade for 2021-2022 school year*
Services Needed*
Hidden
Full Time Discount
Part Time Services Needed - Hillside*
Drop In Services Needed - Hillside*
Full Time Services Needed - Hillside*
Part Time Services Needed - Irvington*
Drop In Services Needed - Irvington*
Full Time Services Needed - Irvington*
Add On
- Early Dismissal
Early Dismissal Services Needed - Hillside*
Early Dismissal Services Needed - Irvington*
Drop In/Early Dismissal Dates*
Child’s youth shirt size:*
- XS
- S
- M
- L
- XL
Doctor Prescribed Food Restrictions, Allergies, Medical Conditions or Special Needs*
Emergency Contacts & Release Persons
Please list the persons you would like contacted (in order of priority) if you cannot be reached in case of emergency
Contact 1 Name*
First Last
Relation*
Address*
Street Address
Phone*
Other Phone
Contact 2 Name
First Last
Relation
Address
Street Address
Phone
Other Phone
Contact 3 Name
First Last
Address
Street Address
Relation
Phone
Other Phone
MY CHILD/CHILDREN SHOULD NEVER BE RELEASED TO THE FOLLOWING PERSON(S) WITHOUT MY EXPRESSED PERMISSION AND/OR COURT NOTICE.
Name
Relation to child
Name
Relation to child
You may reach me at the following number in case of emergency:
Hidden
Discount Subtotals
Hidden
Discount Subtotal
Hidden
DISCOUNTS
Sibling Full-Time Discount
Price: $0.00
Summer Early Registration Discount
Price: $0.00
Total
$0.00
Good Health Statement*

Upon submitting this form, I indicate my child(ren) is/are in good health and condition to attend the program.
I further give Stepping Stones Child Development Centers and/or its staff, permission to have my child(ren) medically treated in case of any medical emergency while in attendance and/or on a trip.
I agree to the following:*
Registration is not complete until the enrollment packet located on the Forms Page is completed and submitted in person or via email at stonesstepping@yahoo.com. Please Note: The enrollment application on page 3 & 4 does not need to be completed. By typing your name above, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application. You also acknowledge that if you are submitting this application today before 12:00 p.m. your child(ren) will receive services the following business day. If payment is made today after 12:00 p.m. services will be received in two business days for processing time. 

Upon completion of this enrollment form, payments are due in person or online through the pay tuition form every Friday. Late fees will be applied after Friday. 

To receive important alerts of our School Closures, Emergency Alerts and Important Reminders, please Like and Follow us on Facebook at Stepping Stones Child Development Centers and Subscribe to receive text alerts by texting: STEPPINGSTONES TO: (833) 766-5592
Consent*
I agree to the following:
FRIDAY- Payments are due prior to service week. Late fees will be applied after Friday.
MONDAY- Payments are past due & Child(ren) will not be accepted into program until payments is made. Payments are due online before 12 p.m. for student to attend the current day of payment.
Thank you in advance for your continued cooperation.

To receive important alerts of our School Closures, Emergency Alerts and Important Reminders, please Like and Follow us on Facebook at Stepping Stones Child Development Centers and Subscribe to receive text alerts by texting:
STEPPINGSTONES TO: (833) 766-5592
Parent/Guardian Signature:*
Date*
MM slash DD slash YYYY
Late Fee
Price:

Enrollment And Tuition Form quantity

Facebook-f

Enrollment And Tuition Form

CHILD 1

CHILD 2

CHILD 3

CHILD 4

CHILD 5

CHILD 6

Emergency Contacts & Release Persons

Discount Subtotals

DISCOUNTS