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2020-2021 Registration Form

About Us
Early Learning Centers
School District Programs
For Parents
For Staff
Contact Us
Apply Now

Please fill out the entirety of this registration form.

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Tuition Agreement
Child's Name*
First Last
Are you an essential worker?*
- Yes
- No
Child's Grade*
Select a Program
Select a District*
Start Date: 8/31/2020
Start Date: 9/8/2020
Select School*
Select Regularly-Attended School*
Select Program Location*
Select Regularly-Attended School*
Program Location: Marsh Creek Sixth Grade Center
Select Program Location*
Select Regularly-Attended School*
Select School*
Select Program Location*
Select Regularly-Attended School*
Select Program Location*
Select Regularly-Attended School*
PROGRAM
Part-time (2-3 days)
Full-time
Program Registration
- Yes, please register me.
Before Care
- $99
- $153
- $20
(7:00-8:25)
After Care
- $164
- $251
- $25
(3:25-6:00)
Before and After Care
- $220
- $345
- $35
(7:00-8:25 & 3:25-6:00)
Instructional Day
- $125
- $175
(7:30AM - 3:30PM)
After Care
- $30
- $50
(3:30 PM-5:30 PM)
Before Care
- $99
- $164
- $15
(7:00-9:00)
After Care
- $220
- $302
- $25
(3:20-6:00)
Before and After Care
- $300
- $402
- $32
Instructional Day
- $125
- $175
(7:00-3:10)
After Care
- $30
- $50
(3:10-5:30)
Before Care
- $156
- $240
- $25
(7:00-9:10)
After Care
- $260
- $340
- $34
(3:45-6:00)
Before and After Care
- $404
- $515
- $46
Before Care
- $120
- $174
- $20
(7:00 - 8:27 - Middle School)
After Care
- $290
- $370
- $38
(3:10 - 6:00 - Middle School)
Before and After Care
- $404
- $515
- $46
(Middle School)
Kindergarten Enrichment 1/2 Day
- $292
- $452
(9:10-12:50 or 12:05-3:45)
Kindergarten Enrichment 1/2 Day + Before Care
- $400
- $595
(7:00-12:50)
Kindergarten Enrichment 1/2 Day + After Care
- $455
- $635
(12:50 - 6:00)
Kindergarten Enrichment 1/2 Day + Before and After Care
- $541
- $754
AM 7:00-12:50 and 3:45-6:00 PM 7:00-9:10 and 12:50-6:00
Kindergarten Enrichment Session
- AM Session
- PM Session
We understand that your child’s Kindergarten session is not yet determined. Please continue registering as spaces can be limited and sessions will be reviewed once known.
Instructional Day
- $125
- $175
(7:30 AM - 3:30 PM)
After Care
- $30
- $50
(3:30-5:30)
Instructional Day
- $125
- $175
(7:30 - 3:45)
After Care
- $30
- $50
(3:45 - 5:30)
* Pricing is per week and due Monday of each week
Registration Fees (Charged Each School Yr.)

$100 per Child
$150 per Family
Registration Fees (Charged Each School Yr.)

$75 per Child
$125 per Family
Registration Fees (Charged Each School Yr.)

$60 per Child
$100 per Family
Part-Time Only
Select Days*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Payment Amount
Total
$0.00
Payment due Monday of each week.

** Late Payment Fee: $15 if tuition is not received by close of business on Tuesday. Late pick up $1.00 per minute after 5:30pm.

Billing and Registration Coordinator will add any applicable discounts
Person(s) designated by parent to whom child may be released:*
I, the parent/guardian: (Please initial)
Received, agree to and have had the ability to ask questions regarding the policies included in the A Child’s Place Family Guide.*
Agree to update the emergency contact/parental consent form information whenever changes occur or every 6 months at a minimum*
Services provided include child care and supervision of on-line learning program.*
ELECTRONIC SIGNATURE – by typing your initial in these fields, you agree that this signature is the electronic representation of your signature for purposes of this document.
Signature of Parent or Guardian*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Parent/Guardian Email Address*
Date*
Date Format: MM slash DD slash YYYY

Enrollment Form
Child's Name*
First Last
School*
What elementary school does your child attend?
Is this registration for a returning student?*
Child's Birthday*
Gender*
Family Information
Child Lives With ...*
Parents are ...*
Are there any custody issues we should be aware of?*
Custody Orders*
Does your family receive state subsidized childcare funding through the ELRC?*
Text messages may be used to notify parents of emergency closings, etc. Please provide your mobile number and carrier for each parent's phone.
Parent's Name*
Phone Number*
Please only insert the number. Do not add any additional text.
Mobile Carrier*
Parent's Name
Phone Number
Please only insert the number. Do not add any additional text.
Mobile Carrier
Child Information
Is your child receiving any intervention type services? (i.e. PT or OT)*
- Yes
- No
Does your child have an IEP (Individualized Service Plan) or IFSP (Individualized Family Service Plan)?*
- Yes
- No
IEP or IFSP Upload*
If your child has an IEP or IFSP, please upload it here.
Video / Photo Release
Do you give permission for images/pictures of your child, captured at A Child's Place, Inc., to be used in newsletters, classrooms (i.e. bulletin boards), social media, and parent communications?*
- Yes, I/we give permission
- No, I/we do not give permission
Physical
Please upload your child's most recent physical complete with doctor's signature and immunizations. Your child's physical must be dated within one year of your start date with ACP.
Upload your child's physical*
I understand that until receiving email correspondence from the ACP office, my registration is not complete and a start date will need to be determined.
I acknowledge that Tredyffrin/Easttown School District has no responsibility or active oversight of my child’s care including, but not limited to selection and supervision of A Child’s Place employees
Signature of Parent or Guardian*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Today's Date*
Date Format: MM slash DD slash YYYY

Emergency Contact Parental Consent Form
55 PA Code Chapters 3270.124(a)(b), 3270.181 & 182, 3280.124(a)(b), 3280.181 & 182, 3290.124(a)(b), 3290.181 & 182
Child's Name*
First Last
Birth Date*
Street Address*
Street Address Address Line 2 City State ZIP Code
Guardian
Guardian's Name / Legal Guardian*
First Last
Relationship to Child*
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Mobile Phone*
Please only insert the number. Do not add any additional text.
Email Address*
Business Name*
Business Phone*
Business Address*
Street Address Address Line 2 City State ZIP Code
Guardian
Guardian's Name / Legal Guardian
First Last
Relationship to Child
Home Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Mobile Phone
Please only insert the number. Do not add any additional text.
Email Address
Business Name
Business Phone
Business Address
Street Address Address Line 2 City State ZIP Code
Emergency Contact
Name*
First Last
Phone # while child is in care*
Name
First Last
Phone # while child is in care
Name
First Last
Phone # while child is in care
Person(s) to whom child may be released
Please enter person(s) OTHER than a parent/guardian with whom child may be released.
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone # while child is in care*
Would you like to add another authorized person?*
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone # while child is in care*
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone # while child is in care*
Name of Child's Medical Provider*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
What is the name of your Health Insurance plan?*
Allergies (including medication reactions)*
Policy Number*
Special Disabilities (if any)*
Medical or dietary information necessary in an emergency situation*
Medication, Special Conditions*
Additional information on special needs of child*
Parents Signature is Required for Each Item Below to Indicate Parental Consent
Obtaining Emergency Medical Care*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Administration of First-Aid Procedures*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Walks & Trips*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Transportation by the Facility*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Parent Signature
Signature of Parent or Guardian*
ELECTRONIC SIGNATURE – by typing your name in this field, you agree that this signature is the electronic representation of your signature for purposes of this document.
Date*
Date Format: MM slash DD slash YYYY
If you would like to enroll another child, please submit this form and then return to the form and start again. If you have a registered account with ACP, your saved information will be pre-populated
Payment Information
I would like to enroll in AutoPay
If you do not wish to enroll in AutoPay, please create an account or log in to MyProCare.

If this is your first time enrolling with us, please wait until you’ve received your enrollment confirmation email to set up an account with MyProCare. The link you'll need to do so will be included in your confirmation email.

About Us
Early Learning Centers
School District Programs
For Parents
For Staff
- Staff Resources
Contact Us
- Careers
Apply Now

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