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.
How Many Weeks?
3 Weeks6 Weeks9 Weeks
Which Days?
July 11 - July 27July 31 - Aug 17Aug 22 - Sept 7July 11 - Aug 17July 31 - Sep 7July 11 - Sept 7
What Times?
Mornings 1: 9:15 am - 11:45 amMornings 2: 9:30 am - 12:00 noonAfternoons: 12:30 pm - 3:00 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 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.

I acknowledge and accept the above.
PARENT INITIALS: