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ADMISSION APPLICATION
OCEAN EARLY CHILDHOOD CENTER

58 Princeton Avenue
Brick, NJ 08724
732-840-0422/Fax 732-840-7655
www.oceanearly.com
DATE RECEIVED___________
CHECK#__________________
AMOUNT $_______________		 CLASS_______________ TIME______________
TEACHER_______________________________
REGISTRATION #_________________________

Director: Vivian K. Dooren
“The Complete Care Facility”
Certified by NJ Dept. of Education
~ Established 1951 ~

CHILD’S NAME __________________________Date of Birth _______________
Residence _________________________________Phone # ( )_________________
                                                                                          City State Zip Code
Father’s Name _____________________ Address (if different from above) ____________________
Mother’s Name ____________________ Address (if different from above) _____________________
Father’s Work # ( ) ___________________ Cell Phone # ( ) ________________
Mother’s Work # ( ) __________________ Cell Phone # ( ) ________________

ALLERGIES ___________________________________________________________________

Other than parent, whom shall we contact in case of an emergency? __________________________
Relationship _____________________________ Phone # ( ) __________________


Restriction on pick up (if any) _______________________________________________________________
The following can pick up my child __________________________ Relationship _________________
_____________________________________________________Relationship _________________
_____________________________________________________Relationship _________________
Doctor's Name _________________________________________Phone # ____________________

FEES:
Tuition Amount _________________                    To be paid in weekly/bi-weekly/monthly
Registration Fee _________________                   Payments of: $ __________From _________
Kindergarten Book Fee ___________                   Through and including __________________
Other Fees _____________________                  
Total Payment Due _______________                        _________________________________
Less Deposit ___________________                                     Signature                       Date

BALANCE DUE ________________

Please check:

3 YR OLD Program ____
      Half Day AM 8:45 - 11:45 ____
      Half Day PM 1:00 - 4:00 ____
      Full Day 8:45 - 4:00 ____
      Childcare Hours 7:00 - 6:00 ____
      Other ____________________		 PRE-K ____
     M/W/F AM 9:00 - Noon _____
      M/W/F PM 1:00 - 4:00 _____
     T/Th Class 9:00 - 1:30 ____
      Full Day 8: 45 - 4:00 ____
      Childcare Hours 7:00 - 6:00 ____
      Other ____________________		 Kindergarten
     Half Day AM 8:45 - 12;15 ____
     PM Enrichment Noon - 4:00 ____
     Full Day 8:45 - 4:00 ____
     Childcare Hours 7:00 - 6:00 ____
     Other _________________

Days: 2 Days (T/TH) _____ 3 Days (M/W/F) _____ 4 Days _____ 5 Days _____ Other ___________

AFTER SCHOOL PROGRAM - Midstreams School ______________________________


Dear Parents,

	In order for us to be effective in meeting your child’s individual needs,
it is important that we know more about his/her background and past experiences.
We invite you to meet with us in discussing any additional information that you
feel would be relevant in helping us know your child.  Please take a few moments
to fill out this important information to help us get to know your child better.

1.  Other children in family and their ages  ___________________________________
2.  Child’s previous group experiences  ________________________________________
    How long did he/she attend?  _______________  Where?  ______________________
3.  Is your child right-handed?  __________	Left-handed?  __________
4.  At what age did toilet training start?  ________________ 
    Age that child was completely toilet trained _____________
5.  Has your child any special habits, fears or idiosyncrasies 
        that we should know about?  __________________________
        ________________________________________________________________________
6.  What type of play activities does your child like?  ________________________
        ________________________________________________________________________
7.  List any ALLERGIES that your child has including food allergies: ___________
        ________________________________________________________________________
        ________________________________________________________________________
8.  In what areas would you expect Ocean Early Childhood Center to help in your
    child’s development?  ______________________________________________________
        ________________________________________________________________________
9.	Do you see your child as being (Circle One)
      	Leader  -  Follower	  Talkative  -  Quiet  Outgoing  -  Shy
     	Even Tempered  -  Moody	Independent  -  Dependent
 

PLEASE READ AND SIGN THE FOLLOWING:

I give permission to the physician selected by Ocean Early Childhood Center to
hospitalize; secure proper treatment for, and order injection, anesthesia or
surgery for my child.  It is further understood that all reasonable efforts
will be made to notify the parents/guardians before any action is taken.  In
the event of an emergency and a responsible person from your child’s card
cannot be reached, the Center may get emergency care for your child.


I understand that tuition is payable monthly, bi-weekly, or weekly and that no
adjustments can be made for student absences for vacations or illness.  A late
fee charge of $25.00 will be added to your tuition if payments are not made by
the 20th of each month.  Return Check Fee is $25.00.

I have read and fully understand the DYFS Information of Parents Document._____
I have read and fully understand the Expulsion Policy.  _____
I have read and fully understand the Discipline Policy and policy on
Communicable Diseases.  _____
 

Parent Name ________________________   Signature _______________________    Date ____________
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