Preschool Enrollment 2025-2026

Join us for the 2025-2026 school year at Roxy Pre-School!

Our mission is to provide an affordable Christian education for children in our local community. We do this in a number of ways, keeping Christ at the center of all we do.
At our school, we provide:
quality education in small groups
a safe and nurturing environment for students
learning through play, Bible, art, music, science, literacy, and math
developmentally appropriate activities and curriculum
communication and support for parents
family events
We believe each student is made in the image of God and we are dedicated to nurturing them academically, spiritually, socially, and emotionally.
Roxy Preschool is proud to be an equal opportunity care provider and employer.

In order for your child to participate in these programs, you must complete this application. All information is required in order for your student to be registered and attend.

This application and the accompanying fee is the first step in registration. Once your application has been processed you will receive an invitation to join Brightwheel, our system for parent communication and billing, if you do not yet have an account with us. Your child's spot in Roxy Preschool will not be secured until the application is submitted and after you have received a confirmation email from education@rpcnet.org

If you do not have a recent health report for your child on file with us, you can download the form here.

On a day school has been in session, Roxy may cancel programming or close its programs early due to unsafe weather conditions. You will receive notification via email and the Breeze app. In the event of an early closure due to a weather emergency, parents are required to arrange for pick up of their child(ren) by the specified closure time.
If you have any questions, please contact us at education@rpcnet.org or preschool@rpcnet.org. We are looking forward to a fun-filled year with your student!

Roxborough Church
8230 Ridge Ave
Philadelphia, PA 19128
Telephone: 215-483-2762

Roxborough Church is an equal opportunity provider.
We do not discriminate against on the basis of race, religion or gender.

Student Information

Name

Date of Birth

Gender

Address

Parent/Guardian 1 Information

Name

Relationship to Child

Address

Phone

This address will receive a confirmation email

Parent/Guardian 2 Information

Name

Relationship to Child

Phone

This address will receive a confirmation email

Address

Emergency Contacts

Parents are the first emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. These individuals will also be approved pickups. Any person listed should be able to assist in contacting you, able to take responsibility for the child in case the parent/guardian cannot be contacted, and should be at least 18 years of age.

Emergency Contact 1

Relationship to Child

Phone

Emergency Contact 2

Relationship to Child

Phone

Emergency Contact 3

Relationship to Child

Phone

Medical Information

Name of Physician

Address

Phone

Insurance Provider

Insurance Policy

Does your child have any physical or mental disabilities? If yes, please explain?

Does your child have any allergies? If yes, please explain

Does your child have an IEP? If yes, please explain

First Aid and Emergency Medical Care Consent

My initials below authorize staff of Roxborough Church who are trained in the basics of first aid to give my child First Aid when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize Roxborough Church to transport my child to the nearest medical care facility and to secure necessary medical treatment for my child. I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in Roxborough Church care.

Child's Name

Parent Signature

Date

Administration of Medication Consent Form

1. All prescriptions and nonprescription medications shall be maintained with the child's name and shall be dated.
2. Prescriptions and nonprescription medications must be stored in the original bottle with unaltered label. Medications requiring refrigeration must be properly stored.
3. Prescription and nonprescription medication shall be administered in accordance with the label directions.
4. Written consent must be provided from the parent, permitting Roxborough Church staff to administer medications to the child. Instructions shall not conflict with the prescription label or product label directions.

Is your child using any medication that needs to be administered during school hours? If yes, please list the medication and give detailed instructions of use.

The signature below authorizes Roxborough Church to administer medication to your child according to the instructions above.

Do you have a copy of your child's most recent health form?

yes no

Please Load Health Form Here

Upload (8MB)

Photos/Media Release Authorization on behalf of Roxborough Church

Do you give Roxborough Church permission to appear in media coverage (tv, newspaper, photographs, websites, etc.)

Child's Name

Parent/Guardian Agreement

General Policies:
1. I am enrolling my child in Roxborough Church's programs.
2. I understand that I must pay the first half of September's tuition of $300 at the time of registration.
3. I understand there is a tuition fee which is due on the 1st of each month by the due date via brightwheel or by check. Failure to pay could result in my child losing their spot in the program.
4. I understand that Roxborough Church will be providing Roxy Preschool from the hours of 8:30am - 3:00pm. I understand Roxy offers aftercare from the hours of 3:00 pm - 6:00 pm for an additional cost.
5. I understand that my child will not be dismissed from the program without being picked up by a parent designated adult.
6. I understand there will be a $25 fee will be added every 15 minutes for late pick-ups.
7. I understand that disrespect, fighting, physical and verbal aggression will not be tolerated in this program. I understand that my child could lose their position in the program and may be discharged immediately for such actions.
8. I understand that if a medical emergency arises, program staff will attempt to contact parents or the emergency contact that I have indicated. It is the parent's resonsibility to notify the staff if this information changes. If immediate medical attention is necessary, an ambulance or emergency vehicle may take my child to the hospital.
9. In case of illness, I understand that my child may not be permitted to attend the program. If staff feels that a child has a contagious disease, he/she may not return to the program without a doctor's note.
10. In order for my child to be considered for this program I understand that I must complete all enrollment paperwork and health assessments.
11. I understand that Roxborough Church's programs are faith-based (Christian).
12. I have received complete program information (handbook) at the time of enrollment (PA Code 3270.121, 3280.121, 3290.121).
13. I agree to update the emergency contact and parental agreement when changes occur or every 6 months at a minimum (PA Code 3270.124, 3280.124, 3290.12

Parent Electronic Signature

Non-discrimination in Services

SUBJECT: Nondiscrimination in Services

TO: Parents/Guardians

FROM: Jessica Peale (Director of Education)

Admissions, the provisions of services and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age or sex.
Program Services shall be made accessible to eligible persons with disabilities through the most practical and economically feasible methods available. These methods include, but are not limited to, equipment redesign, the provision of aides and the use of alternative service delivery locations. Structural modifications shall be considered only as a last resort among available methods.
Any individual/client/patient/student (and/or their guardian) who believes they have been discriminated against, may file a complaint of discrimination with:

Roxborough Church
8230 Ridge Ave.
Philadelphia, PA 19128

Commonwealth of Pennsylvania Department of Human Services Bureau of Equal Opportunity
Room 225, Health & Welfare Building P.O. Box 2675
Harrisburg, PA 17105

U.S. Department of Health and Human Services
Office for Civil Rights
Suite 372, Public Ledger Building 150 South Independence Mall West
Philadelphia, PA 19106-9111

Electronic Signature

Dismissal, Discipline, and Discharge Policy

Children are not permitted to arrive alone and must be signed in by an adult.

Children are only permitted to be signed out by an approved pickup over the age of 18.

The fee for late pick up is $25 per 15 minute interval. Excessive lateness will be reviewed.

Children are not permitted to bring any toys from home.

A child who displays chronically disruptive behavior may be suspended or discharged at the discretion of the camp supervisors.

Unacceptable Behavior of the Participant:

Electronic Signature

Payment

Signature - I understand that I will be charged a non-refundable $300 deposit

Today's Date

Payment $30

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Preschool Enrollment 2025-2026

Description

Please Fix the Following