Preschool Enrollment Welcome

PRESCHOOL ENROLLMENT WELCOME

Preschool Name: Enrollment Date:

STUDENT INFORMATION

Date of Birth: Student ID (if assigned):

PARENT / GUARDIAN INFORMATION

Primary Phone: Alternate Phone:

EMERGENCY CONTACTS & AUTHORIZED PICKUP

Relationship: Phone:

Relationship: Phone:

HEALTH, MEDICAL & ALLERGY INFORMATION

Immunization Status: Up to date Medical or religious exemption on file

PERMISSIONS & CONSENTS

Photo/Video Release: I grant permission for my child to be photographed or videotaped for school educational use and publications. I do NOT grant permission

Field Trip Permission: I give permission for my child to attend supervised local outings and short bus trips with prior notice. I do NOT give permission

Administration of Sunscreen / Topical Products: I authorize staff to assist with/apply provided sunscreen or topical barrier creams. I do NOT authorize

TUITION, SCHEDULE & PAYMENT

Scheduled Days: Start Date:

Payment Plan: Monthly Semi-monthly Weekly Annual

Late Payment Fee Acknowledgment: I understand that accounts not paid by the due date will incur a late fee in accordance with the preschool's published fee schedule, and continued nonpayment may result in suspension of services until the account is brought current.

POLICIES, ACKNOWLEDGMENTS & RELEASE

Drop-Off / Pick-Up: Authorized persons must sign the child in and out. The preschool is not responsible for the child prior to sign-in or after sign-out. Unapproved release of a child to persons other than those authorized may require written consent or photo identification at pickup.

Illness & Exclusion Policy: I acknowledge the preschool's authority to exclude my child if signs of contagious illness are present. I agree to promptly pick up my child if requested and to follow the preschool's health and communicable disease policies.

Medication Administration: Prescription or over-the-counter medications to be administered by staff require a signed authorization with dosage and schedule. Medications must be in original labeled containers.

Liability Release: To the fullest extent permitted by law, I release the preschool, its employees, and agents from liability for ordinary negligence in connection with my child's participation in program activities, except for willful or grossly negligent acts. This release does not apply to medical treatment necessitated by gross negligence or intentional misconduct.

Handbook Acknowledgment: I acknowledge receipt of the preschool handbook and agree to abide by the policies and procedures contained therein.

EMERGENCY MEDICAL AUTHORIZATION

In the event of a medical emergency and the preschool is unable to reach me, I authorize preschool staff to seek and consent to emergency medical treatment for my child, including transport by ambulance and necessary emergency care as determined by medical personnel.

Child's Name: Parent/Guardian Name:

CONSENT & CERTIFICATION

By signing below I certify that the information provided on this enrollment form is true and complete to the best of my knowledge. I authorize the preschool to verify information relevant to enrollment and to communicate with listed emergency contacts and health care providers as necessary for care of my child. I understand that withholding medical or allergy information could endanger my child and may result in termination of enrollment.

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