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
    5 Days (1) Payment - $2,610.005 Days (9) Payments - $290.005 Days (10) Payments - $261.00

    3-Days
    3 Days (1) Payment - $1,935.003 Days (9) Payments - $215.003 Days (10) Payments - $194.00

    2-Days (Preschool Only)
    2 Days Preschool (1) Payment - $1,575.002 Days Preschool (9) Payments - $175.002 Days Preschool (10) Payments - $158.00

    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. Bus Instructions: If your child is riding the bus, are there any special instructions for care such as “my child gets motion sickness, please seat them at the front of the bus.”
    3. Publicity Permission YesNo
    4. 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