KCC 2026-2027 Preschool Registration • North Central Church

Thank you for your interest in enrolling your preschooler in Kid Central CNY's Preschool Program for the 2026-2027 school year. Our program options are below:

3 year old program: 3 days/week M/W/F. Optional: 5 days/week M-F | 9:00-11:30am

4 year old program: 5 days/week M-F | 9:00-11:30am

Monthly Tuition: 3 days/week $249 or 5 days/week $299.

Registration fee (non-refundable): $100

20% off registration fee if received by March 31, 2026

(Invoice will be sent via email. Payment can be made online; click the link within the email.)

Please follow the steps below and SUBMIT:

Step 1 - Complete all fields in the form below for each child being registered.

Step 2 - Submit form.

After the registration form is submitted and processed, you will be contacted via email with the additional items needed to fully complete the registration process.

We are looking forward to serving your family at Kid Central CNY Preschool!

*NOTE*: This form will "time-out" if left unattended. Be sure to have the following information ready before beginning - medical insurance & 2 emergency contacts information.

Child Information

Child's First Name *

Child's Last Name *

Home Address *

Home Address Line 2

Home City *

Home State *

Home Zip Code *

Primary Language *

Date of Birth *

Child's Current Age *

Gender

Parent/Guardian Information

Primary Contact First Name *

Tip: *this will be the primary account contact for billing and communications

Primary Contact Last Name *

Cell Phone Number *

Email Address *

Employer Name *

Employer Phone *

Address (if different from child)

Secondary Contact First Name

Secondary Contact Last Name

Cell Phone Number

Tip: Note: If a secondary contact is not listed, please re-enter the primary contact's cell phone number.

Email Address

Employer Name

Employer Phone

Address (if different)

Child's Medical/Insurance Information

A copy of your child's current physical is required to be provided prior to his/her first day of preschool.

Physician's Practice Name *

Physician's Name *

Phone Number *

Address *

Date of Last Physical Examination

Does your child have any disabilities, chronic medical conditions, or allergies which require special consideration or care by Kid Central CNY staff? *

Yes

If yes, please give details.

Does your child need a 1:1 aide? *

Yes

Is your child currently taking regular medications? *

Yes

If yes, please describe your child's regular medications.

Insurance Subscriber's First Name *

Insurance Subscriber's Last Name

Insurance Carrier *

Policy/ID Number *

Emergency Contact Information

Please list (2) Emergency Contacts (other than child's parents) whom Kid Central CNY staff may contact in the event of an emergency if the parents cannot be reached.

Note: Copy of each person's driver's license is required.

By completing and submitting this form, I authorize the following Emergency Contacts to pickup my child in the event of an emergency if parent(s) cannot be reached.

Emergency Contact Name 1 *

Relationship to Child *

Emergency Contact # 1 Phone Number *

Address *

Emergency Contact Name 2 *

Relationship to Child *

Emergency Contact # 2 Phone Number *

Address *

Billing Contact

Please complete this section with the primary billing contact's information. This is the person who will receive invoices and make payments.

Who should invoices be sent to? (First and Last Name) *

Email Address *

Phone Number *

Permissions & Authorizations

The below digital signatures shall constitute an original for all purposes set forth. Please provide full name.

Emergency Medical Treatment Authorization

I hereby give Kid Central CNY staff members permission to administer basic first aid and/or CPR to my child, as named below, and/or take my child, as named below, to a hospital for medical treatment when I cannot be reached or when delay would be dangerous to my child's health.

Child's First/Last Name *

Parent/Guardian Digital Signature *

Today's Date *

Parental Visit Notice

I understand that I may visit the Kid Central CNY Preschool programming unannounced at any time during the hours that my child is in care.

Parent/Guardian Digital Signature *

Today's Date *

Permission to Administer Over-The-Counter Topical Products

I give permission to Kid Central CNY to apply the topical, over-the-counter products I have checked below to my child, according to the label and/or package instructions. I agree that a brand name or generic product will be used, unless I have supplied Kid Central CNY with a specific product brand. All parent-supplied over-the-counter products must be kept in their original packaging and labeled with child's first and last name. Please bring in products that have a printed expiration date on the packaging.

Topical Products to Administer (Please select all that apply.) *

Child's First/Last Name *

Parent/Guardian Digital Signature *

Today's Date *

Policy Regarding Release of Children

I understand that Kid Central CNY accepts responsibility for my child upon his/her arrival to the program. Kid Central CNY will not be responsible after my child leaves the program as authorized on the enrollment form. Chidren will be allowed to leave the program with persons other than the parent only if written permission has been given to Kid Central CNY staff. I understand that any changes to the arrival/departure arrangements must be made in writing to the Kid Central CNY staff.

Parent/Guardian Digital Signature *

Today's Date *

Authorization for Photographs and Video Recording

Photography/Videography Permission (Please select one option.) *

I GIVE permission for my child to be photographed and videoed in Kid Central Preschool. I understand these pictures/videos will be shared with parents, displayed within the facility, or possibly used on our website or social media.

I DO NOT GIVE permission for my child to be photographed and videoed at Kid Central CNY programming and activities.

For Office Use:

How Did You Hear About Us?

Program Applying For

Child Information

Parent/Guardian Information

Child's Medical/Insurance Information

Emergency Contact Information

Billing Contact

Permissions & Authorizations

Emergency Medical Treatment Authorization

Parental Visit Notice

Permission to Administer Over-The-Counter Topical Products

Policy Regarding Release of Children

Authorization for Photographs and Video Recording