Village Preschool of Portland, Inc.
Date this form was submitted: ________________________________
Please return completed forms, along with the $100 non-refundable application fee by mail to: Village Preschool of Portland, P.O. Box 19449, Portland, OR 97280. You may also return your completed forms via email to info@villagepreschoolofportland.com
Child’s Name (first, middle, last) | |||
What name does your child prefer to go by? | |||
Birth Date: | Gender: Male Female | ||
Which class is your child applying for? (circle one) | If your child is 2.5 years old by Sept. 15 & potty trained, they are eligible for the Junior Class | If your child is 4 years old by Sept. 1st they are eligible for the Senior Class | |
Number of School Days ____ *We make our best effort to honor family preference for school days.* | Juniors may choose 2-4 days a week. Please rank your preferred school days 1-4. Mon.___ Tues.___ Wed. ___ Thurs.___ | Seniors may choose 3-5 days a week. Note that Fridays are Seniors only and are compulsory. Please rank your preferred school days 1-5. Mon.___ Tues.___ Wed. ___ Thurs.___ Fri.___ | |
Please add any information about your preferred schedule. ________________________________
Name of Parent/Guardian #1 | Name of Parent/Guardian #2 |
Address | Address (if different than #1) |
Phone #1 Phone #2 | Phone #1 Phone #2 |
Preferred Method of Communication (please circle one): Phone Text Email *This information will be included on class rosters. | Preferred Method of Communication (please circle one): Phone Text Email *This information will be included on class rosters. |
This information might be helpful for members interested in setting up childcare exchanges, getting to know the community etc.
Sibling Name | Sibling Birth Date |
How did you hear about Village Preschool of Portland? |
•Village Preschool does not discriminate on the basis of race, color, national or ethnic origin.
Village Preschool of PortlandHealth and Emergency Authorization Form
Date completed: ________________________
Child’s Name (first, middle, last) | ||
Birth Date: | Weight: | |
Parent/ Guardian #1 | Parent/ Guardian #2 | |
Address | Address (if different from #1) | |
Home Phone | Home Phone | |
Cell Phone | Cell Phone | |
Work | Work | |
(List phone numbers in the order you wish the school to call, in case of an emergency.)
Name | Relationship to the child | Phone Number | Description of Number (Mom cell, Dad work, Grandma, etc.) | |
#1 | ||||
#2 | ||||
#3 | ||||
#4 | ||||
#5 |
Medical/Dental
Pediatrician | Phone |
Dentist | Phone |
Please list any other medical professionals your child has that may need to be contacted by medical staff in an emergency (allergist, cardiologist …etc.) | |
Name | Phone |
Insurance
Insurance | |
Employer | Employer Phone |
Subscriber | Subscriber ID |
Group ID | |
Consent for Medical Treatment
______ By my initials, I hereby authorize Village Preschool of Portland, Inc. (VPS) to give consent for all medical and/or surgical treatment that may be necessary for my child during my absence or unavailability.
Health
Existing Medical Conditions |
Current Medications and Dosages |
Allergies *If your child has food allergies, please contact the VP/Membership Chair for additional forms. |
Any special characteristics (physical or emotional) of your child? Any specific concerns (extended illness, speech problems, allergies, medications, death in the family, divorce, etc.)? Please attach another page if necessary. |
The above-named child has had the proper immunizations and is physically fit to attend Village Preschool.
Parent Signature: ________________________________________________________ Date: _______________________
Authorized Pick Up List
Please list the first and last name and phone number of anyone (e.g., babysitter, neighbor, another Village parent, grandparent) who is authorized to pick your child up at school.
First Name | Last Name | Relationship to the Child | Phone Number(s) |
Village Preschool of Portland, Inc.
Membership Agreement Form
Child’s Name: _______________________________________________________
Village Preschool, a cooperative preschool, provides a wonderfully enriching experience for children and parents alike. Of course, a “cooperative” preschool by definition demands the active participation of all of its members. The following is Village Preschool’s membership agreement, a covenant that ensures the smooth operation of the entire school program.
By signing below, you demonstrate your willingness to become a member of Village Preschool and fulfill your family’s obligations to the school. More importantly, you make a commitment to creating the best possible learning environment for your child.
AS A MEMBER OF VILLAGE PRESCHOOL, I AGREE TO:
1. Turn in registration, health and emergency authorization, immunization forms, and any other required paperwork to the Vice President or other appropriate person before my child begins attending Village Preschool.
2. Read the school handbook carefully, and complete page 1 for my records. The handbook will be distributed at the Fall Orientation Meeting. (Please contact the Membership Chair for the current year’s handbook if you wish to read it before signing below).
3. Complete an Oregon Central Background Registry request form for everyone who will volunteer in the classroom or drive on field trips. The results of the background check will be confidential and will be handled on a case-by-case basis.
4. Perform my Village Preschool job, including reading and consulting my job description and asking for guidance from the appropriate person if I do not understand my duties.
5. Pay the $200 operating fee, any other fees, and first month’s tuition by Fall Orientation. The non-refundable operating fee is typically collected at the Spring Membership Meeting of the preceding year.
6. Pay tuition via the Jovial app or check by the 1st of each month and no later than the 10th of the month.
7. Attend all mandatory meetings (up to five) or agree to pay the appropriate fee for my absence, or make up the absence with an outside job as assigned by the Lead Teacher or Board if available.
8. Arrive at school by 8:45 a.m. on the days I am scheduled to be a grownup helper in the classroom.
9. Arrange in advance to swap grownup help shifts if necessary, using the emergency alternate only in the case of a true emergency.
10. Fulfill the $500 fundraising requirement for the year, as well as participate in and attend the Silent Auction fundraiser. In the event that our family is unable to meet the fundraising requirement, we agree to reach out to the Fundraising Chair to identify an alternative arrangement.
11. Participate in 4 (four) annual work parties (school maintenance days)
Parent’s Name: ________________________________________________ Date: ________________________
Signature: ____________________________________________________
Village Preschool Job Request Form
Child’s Name: ______________________________________ Parent’s Name:___________________________________________
Phone #: ______________________________ Email: ____________________________________________ Class: ______________
Please indicate your job preference by numbering your choices 1 thru 5. Most of the jobs below only require one person. Everything possible will be done to accommodate your choices but due to varying circumstances, it may not be feasible. The job descriptions below have been condensed. All job descriptions are subject to change. For a complete and current listing of jobs and job descriptions, contact the Jobs Coordinator.
Board Positions (Requires attendance at board meetings once a month) | Non-Board Positions | ||||||
President Presides over all meetings and sees that board decisions are carried out. | Secretary Takes and distributes the minutes from all meetings, collects and sorts mail. | Equipment / Supplies Purchases new equipment and general supplies. Coordinates minor repairs of equipment and in classroom maintenance. | Immunization Coordinator Handles processing of immunization records. Maintains emergency and first aid. | ||||
V.P./Membership Chair In charge of membership and registration. | Fundraising Chair Plan, organize and oversee all fundraising events. | Grown Up Help Coordinator Organizes parent help sign-ups 3-4 times/year. Posts schedule on calendar and in the classroom. Updates changes in calendar. | Work Party Coordinator Coordinates laundry rotation sign ups. Schedules, facilitates and attends work parties. Records attendance for work parties. | ||||
Treasurer Maintains budget, monthly financial statements, payroll, taxes, deposits and expenses. | Marketing Coordinator Leads advertising and marketing needs for Village. | Snacks / Hospitality Purchased snacks for the classroom. Arranges set/clean up for all member meetings. | Webmaster Maintains & updates the school’s website and social media pages. | ||||
Jobs Coordinator Assigns Jobs to families. Ensures everyone has information to perform their job. | Class Rep Liaison between board and membership and coordinates Sr. field trips | Tuition Coordinator Collects, records and deposits tuition payments. Coordinates the Lunch and Play sign-up sheet. | PCPO Rep Attends monthly PCPO meetings and reports to membership or Board. | ||||
Fundraising Committee (3) Assists fundraising chair as needed | Laundry Takes home & washed dirty laundry weekly. Mends items as needed. | ||||||
Please indicate any position that you would absolutely not be willing to take: ____________________________________________
Would you be willing to consider a board position? (please circle one) Yes No
*Please note that Board Members have a reduced requirement of 1 work party per year.
Please list any special skills/experience that would be particularly helpful in a specific job: __________________________________ ___________________________________________________________________________________________________________
Signature: _____________________________________________________ Date: ___________________________________
2026-2027 Tuition & Fees
All Fees and Tuition are subject to change
Tuition - Juniors
2 days/week | $2,840 per school year ($284 per month Sept-Jun) |
3 days/week | $4,260 per school year ($426 per month Sept-Jun) |
4 days/week | $5,680 per school year ($568 per month Sept-Jun) |
Tuition is due by the 1st of the month (no later than the 10th)
Tuition - Seniors*
3 days/week | $4,610 per school year ($461 per month Sept-Jun) |
4 days/week | $6,030 per school year ($603 per month Sept-Jun) |
5 days/week | $7,450 per school year ($745 per month Sept-Jun) |
Tuition is due by the 1st of the month (no later than the 10th)
*Additional $35 per month for 4 hour day on Fridays
Application Fee | $100 (non-refundable) | Due when application is submitted |
Operating Fee | $200 (non-refundable – this holds your place in the class) | Due at Spring Orientation Meeting |
Background Check | $5 (per background check) | Mandatory for every grownup in the classroom |
Lunch & Play | $9 per day | Due with tuition payment the month following the L&P days |
Fundraising | $500 per school year | Each family is asked help with fundraising through our Direct Give and Auction |
Fees & Fundraising
Revised 12.11.2025