Summer Camp Copy

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. 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: