2023-2024 Enrollment Form
Jenkins Day School is now enrolling for the 2023-2024 School Year which begins on Tuesday, Sept 5th, 2023 and Wednesday, Sept. 6th, 2023.  Please submit form and you will be notified via email within one week if your application has been approved and if we have availability. You will then have 1 week to remit a non-refundable $75 annual registration fee and $115 supply fee payable by cash or check to Jenkins Day School in order to secure your spot. No refunds will be given unless we are unable to place your child.  Applications are accepted on a first come, first serve basis. Please fill out one form per student.  Daily tuition rates are $35 and monthly tuition fees will be an average of total days/9 months.  
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Child's First Name: *
Child's Last Name: *
Child's Date of Birth: *
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Age of Child on August 15th:   *
First Choice Program Option: *
Second Choice Program Option: *
Name of Parents/Guardian: *
Name and Ages of Siblings: *
Home Address: *
Phone Number(s): *
Email Address: *
Father Occupation/Place of Employment: *
Mother Occupation/Place of Employment *
Emergency Contact(s) and Phone Number(s): *
To insure the safety of your child, please list other adults to whom your child may be released, including phone numbers: *
Child's Physician and Phone Number:
Immunizations Current? (Please provide proof) *
Do you have a church home? *
If yes, where?
Has your child ever attended a program before? *
If yes, where? *
Allergies, reactions, preferred treatment? *
How does your child like to be comforted? *
Is your child potty trained? *
Favorite Activities, Foods, etc. *
Child's normal disposition (ie. Quiet, Active, Outgoing, etc) *
How do you handle discipline at home? *
Additional Comments/Information about your child? *
By signing below, I give permission to Jenkins Day School to take whatever emergency (ex. First Aid, Disaster evacuation, etc) measures judged necessary to insure the care and protection of my child while under the supervision of the staff.  In case of a medical emergency, I understand that my child may/will be transported to the nearest hospital by the local emergency unit for treatment if deemed necessary.  I understand that payment for emergency medical treatment will be the responsibility of the parents/guardian’s medical, dental or accident insurance or in such instances where insurance is not available, the treatment will be the sole responsibility of the parent/guardian.  I, hereby, understand that Jenkins Day School will not be held liable for accidents or injuries that might occur.  I further relieve the church and its staff of any responsibility for any injury my child or I may incur while on property.   By enrolling in Jenkins Day School, I understand that they are not a “drop-off” childcare and I will be responsible for paying the full month’s tuition, even when my child is not present. (Please sign your name) *
I have read the Jenkins Day School Handbook (revised Aug, 2021) and understand the Covid-19 and Illness Policies set forth.  I understand that the staff can deny my child's admission for the day for heath concerns; and will call for immediate pick up should he/she become ill during the day. (Please sign your name) *
I understand that Jenkins Day School and Jenkins C.P. Church staff is taking necessary precautions, outlined by the CDC, to prevent the spread of COVID-19.  I understand the risks of bringing my child to Jenkins Day School and hereby relieve the church and its staff of any responsibility for any illness my child or I may incur as a result.   I vow to inform staff of any changes in the health of my child and/or family and if there has been contact with someone diagnosed with COVID-19.   (Please sign your name) *
One of the most exciting promotional tools used in childcare is the use of photos showing your children in action.  Please indicate if we may use pictures of your child for use in future publications, newsletters, brochures, multimedia presentations, JDS website and church website and store these photos on discs for purposes of archiving.   *
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