Preschool & Toddler Care in Spring Hill, TN

Enrollment Application Form

Step 1 of 4

Child’s Full Name:

Nickname

Birth Date:

Gender:

Soc. Sec. #

Mother's Name

Father's Name

Mother's Address:

Father's Address:

Mother's ZIP:

Father's ZIP:

Mother's DL#

Father's DL#

Mother's State:

Father's State:

Mother's Soc. Sec. #

Father's Soc. Sec. #

Mother's Home Phone

Father's Home Phone

Mother's Work Phone

Father's Work Phone

Mother's Cell Phone

Mother's Phone Carrier

Father's Cell Phone

Father's Phone Carrier

Mother's permission to receive text messages?

Father's permission to receive text messages?

Mother's Email

Father's Email

How did you hear about us?

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

Family Physician:

Physician Phone

Name

Phone

Name

Phone

Name

Phone

Special Instructions:

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. I certify that this application is correct.

Parent or Guardian’s Signature

Date:

Due to COVID-19, Spring Hill Academy has been exploring different and reasonable ways to provide services to all students while continually monitoring and updating information. The Academy is working with the Tennessee Association of Christian Schools, who maintain contact with state and local agencies, including the state health department, to keep updated and to draft and implement guidelines moving forward regarding cleaning, screening, etc. We have been working hard to update and implement our procedures, and will continue to work hard to implement and abide by prudent safety guidelines, neither the guidelines themselves nor even guidance from the Centers for Disease Control and Prevention (“CDC”) would allow the Academy to guarantee an environment that is entirely free of COVID-19 related risks, as I am sure you understand.

By allowing your child to return to school, however, you acknowledge and understand that your child’s attendance will require him/her to interact physically with the staff members and other students. As such, despite reasonable and prudent mitigation efforts by the school, physical interaction with the public at large may pose some unavoidable risks to you, your child, and your family due to COVID-19 and/or other communicable illnesses. With that, you further acknowledge and agree to the following:

1. Waiver and Release. You hereby release and forever discharge and hold harmless the Spring Hill Academy and its agents (any employee, client, agent, owner, shareholder, board member, or any other representative of the Academy) from any and all liability, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from your child’s return to campus and/or participation in activities associated with the Academy. You understand that this release discharges the Academy from any liability or claim that you may have against the Academy with respect to COVID-19.

2. Assumption of Risk. You further understand that your child’s return and/or participation may expose him/her and others to unavoidable COVID-19 community spread, even with mitigation efforts. As such, you hereby expressly and specifically assume the risk of injury or other harm, and also expressly release the Academy and its agents (any employee, client, agent, owner, shareholder, board member, or any other representative of the Academy) from all liability for injury, illness, or other issue resulting from or in any way related to your child’s return or participation.

BY EXECUTING BELOW, YOU ACKNOWLEDGE HAVING READ AND UNDERSTOOD ALL OF THE ABOVE-TERMS AND CONDITIONS.

Your Child’s Printed Full Name

Your Relationship to the Child

* Your Printed Full Name

Your Signature

Date of Signing