Preschool Enrollment Form

My Child

Child's Name

Birthdate

List Siblings and Ages:

Parent's Names

Parent's Address

Classes and Payment Options

5-Days
(1) Payment - $2,126.00(9) Payments - $236.00(10) Payments - $213.00

3-Days
(1) Payment - $1,607.00(9) Payments - $179.00(10) Payments - $161.00

2-Days
(1) Payment - $1,323.00(9) Payments - $147.00(10) Payments - $132.50

Extended Day Options
(1) Day/Week - $55.00(2) Days/Week - $105.00(3) Days/Week - $145.00(4) Days/Week - $175.00(5) Days/Week - $200.00

Mother's Contact Information

This will be used for school communications only and will not be shared.

Cell Phone

Work Phone

Email

Father's Contact Information

This will be used for school communications only and will not be shared.

Cell Phone

Work Phone

Email

Emergency Contact 1

Must be relationship other than parent.

Name

Relationship to Child

Phone

Emergency Contact 2

Must be relationship other than parent.

Name

Relationship to Child

Phone

Medical Information

Physician's Name

Phone

List Any Allergies:

List Any Special Needs:

List Any Regular Medicines:

Parent's Consent
  1. Emergency Medical CareAdministration of prescription medicine with a written doctor’s note and exact dose.Administration of non-prescription medication with a written note and exact dose.Field TripsTransportation by school bus for field trips
  2. YesNo
  3. Publicity, permission to use your child’s name and/or photograph when in school activities in local newspapers, our website, or our Facebook page.

* Required