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 - $3,226.005 Days (9) Payments - $358.005 Days (10) Payments - $323.00 3-Days 3 Days (1) Payment - $2,391.003 Days (9) Payments - $265.003 Days (10) Payments - $240.00 2-Days (Preschool Only) 2 Days Preschool (1) Payment - $1,947.002 Days Preschool (9) Payments - $216.002 Days Preschool (10) Payments - $195.00 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 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 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.” Publicity Permission YesNo 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
