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                               Parent Referral Form           (Click here to print this form.)

If you refer a family to us and they enroll a child in child care preschool you will receive a cash payment as your referral fee. You will receive $200.00 for part time and afterschool care. $400.00 for a full time family. After the “referred child” has been enrolled and attended the Center for 60 days, you will then receive the fee. This incentive program applies to new enrollments only.  We hope you will take full advantage of this program. This program will let us know that you are truly confident in our care and we thank you.

Existing Client Name: _________________________________________

Daytime Phone #: ____________________________________________

 

Referral #1 ___________________________________________

Address: ______________________________________________

Phone #: ______________________________________________

Child’s Name/D.O.B.: _____________________________________

 

 

Referral #2 ___________________________________________

Address: ______________________________________________

Phone #: ______________________________________________

Child’s Name/D.O.B.: _____________________________________

 

 

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Clarence Center Preschool, Inc.
5990 Goodrich Rd. P.O. Box 152
Clarence Center, NY  14032
(716) 741-2606