Enrollment Application


Child’s Full Name

Nickname

Birth date

Gender

BoyGirl

Soc. Sec. #

Mother

Name

Soc. Sec. #

Father

Name

Soc. Sec. #

Emergency Contacts (other than parents) & People Permitted to Pick Up Child:

Parent/Guardian Agreement

I hereby give my consent to have my child treated by a physician for medical or surgical care should an emergency arise. I understand that every effort will be made to contact me, or one of the names listed above, before such action is taken.

I agree to pay the tuition due, in advance and on a weekly basis, for the time my child is enrolled. I understand that late fees will be added for any tuition not paid on time. I understand that I may withdraw at any time by notifying the school office one week in advance, in writing, and all tuition and fees are payable upon other absences. I agree to pay any and all fees associated in any way with the collection of any unpaid tuition and/or late fees.

I hereby give my consent to have my child photographed and his/her picture placed on display at the preschool, on the school website, reproduced and printed in our school annual, and used in our annual Christmas and Spring Program DVDs. I also give permission for my child’s pictures to be used for marketing and teacher training purposes.

I have received a copy of the Department of Education “Childcare Approval Requirements” for preschools, and a copy of the Preschool Parent Policies and Child Abuse Policy statement and agree to abide by those policies. I also agree to confer with the school first if I have any questions or problems, as required by Matthew 18:15.


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