Please enter YOUR information below
First Name
*
Last Name
*
Cell Phone
*
Email
*
Address
*
City
*
State
*
Zip code
*
2nd Parent Full Name
2nd Parent Cell Phone
Child 1 Full Name
*
Child 1 Date of Birth
*
Child 1 Gender
*
Male
Female
Child 1 Allergies
*
Child 1 Notes
*
Add another child?
*
Yes
No
Child 2 Full Name
Child 2 Date of Birth
Child 2 Allergies
Child 2 Notes
Child 2 Gender
Male
Female
Add another child?
Yes
No
Child 3 Full Name
Child 3 Date of Birth
Child 3 Allergies
Child 3 Notes
Child 3 Gender
Male
Female
In addition to those listed above, the following individuals may pickup my child:
Authorized Adult 1 Full Name
Authorized Adult 1 Phone
Authorized Adult 2 Full Name
Authorized Adult 2 Phone
Authorized Adult 3 Full Name
Authorized Adult 3 Phone
To keep our preschool running smoothly, please agree to all of these policies:
I agree to pay the monthly tuition by the first class of each month, as well as the non-refundable registration fee to reserve my child’s place and pay for his/her school supplies.
I give permission for my child’s photograph(s) and/or videotaping(s) to be used for preschool marketing materials offline and online, newsletters, and art projects.
I agree to abide by the Policies & Procedures Handbook which has been explained to me.
Parent Agreement
*
I agree to all of the policies listed on this form.
Parent Signature
Clear
Date Signed
