Registration Form

    Your Name (required):

    Your Email (required):

    Your Phone (required):

    Getting to Know You and Your Child

    Child’s Name:
    Nickname:

    Birthdate:

    Address:
    Address (apt. suite):
    City:
    State:
    Zip code:

    Parent’s (or legal guardian’s) Name:
    Phone:
    Email:

    Address:
    Address (apt. suite):
    City:
    State:
    Zip code:

    Parent’s (or legal guardian’s) Name:
    Phone:
    Email:

    (If same address, you may skip this)
    Address:
    Address (apt. suite):
    City:
    State:
    Zip code:

    Siblings Names and ages:

    1. Does your child have any allergies or medical conditions that would
    be relevant to providing care for your child?
    Please explain:

    2. Please describe your child’s personality:

    3. What types of toys or activities does your child enjoy?

    4. Is your child currently receiving services (speech, OT or counseling)?
    YesNo
    4a. If Yes, please explain:

    5. Does your child have any special needs (toileting, etc.)?

    6. Does your child have any specific fears?

    7. What is your child’s first language? Second language?

    Additional Authorized Pick-up People
    Who else can pick up your child?

    Name:
    Relationship to Child:
    Phone:

    Name:
    Relationship to Child:
    Phone:

    CLASSES

    Please check the class(es) you are interested in. Please remember to ask if there is not a choice to your liking and we’ll be happy to try and accommodate your needs, however, registration is on a first come, first served basis.

    2 Year Old Class Choices:
    Tuesday & Thursday 9:00 a.m. - 11:00 amTuesday & Thursday 11:30 - 1:30 pmTuesday & Thursday 2 - 4 pmMon, Wed & Friday 12:30 - 2:30 pm5 days Mon - Friday

    3 Year Old Class Choices:
    Tues & Thurs 9:30 am - 12 noonMon, Wed & Fri 9:30 - 12:00 noonMon, Wed & Fri 12:30 - 3:00 pmTues & Thursday 12:30 - 3pm4 days per week 12:30 - 3pm5 days 9:30 - 125 days 12:30 - 3pm

    4 Year Old Class Choices - Pre-K
    Mon, Wed & Fri - 9 a.m. - 11:30 am4 Days per week 9:15 - 11:45 am5 days Mon - Friday 12:15 - 2:45 pm5 days Mon - Friday 10:15 - 12:45 pm

    Acknowledgements

    Please Read below and Acknowledge with your digital initials
    Please register my child for September 2022 ($95 registration fee)
    I understand and consent that once my child is registered, payments are due one month ahead (Aug - May). I understand in order to remove my child from the preschool, I must provide a written letter 30 days prior to dismissal. There are no refunds available for monthly fees paid prior to removal.

    I hereby agree to read and follow the policies and procedures of Miss Midgies Preschool located in Miss Midgies Preschool Parent Handbook. I understand that the rules are set for the protection of myself, my child and others in the school. I understand that I cannot hold anyone liable for accidental injury suffered during my child’s time at the preschool. I understand that the Preschool is a peanut free school and will not send any peanut items into the preschool at any time.

    I understand that tuition is based on a YEARLY basis regardless of how many days in a month, amount of holidays or personal vacation plans, tuition remains the same. For my convenience it is broken down into 10 monthly payments.

    I also understand that my tuition must be paid in full unless otherwise having written documentation from a doctor that a child must leave the school due to illness or injury with at least 30 days written notice.


    PARENT INITIALS: