Child's Full Name *
Child's Full Name
Please check
Birth Date
Birth Date
Phone
Phone
Address
Address
Mother's work Phone
Mother's work Phone
Mother's cell phone
Mother's cell phone
Father's work phone
Father's work phone
Father's cell phone
Father's cell phone
Physician phone number
Physician phone number
Emergency Contact phone
Emergency Contact phone
Emergency Contact phone
Emergency Contact phone
I am paying registration in the amount of $________ for the above-named child to be enrolled in the Preschool Summer Session for the following weeks. I will pay the weekly tuition in the amount of $_______ by June 10th. I understand that if tuition is not received by that date, I forfeit my child's place in your school. Tuition is due on the first day of each week for any additional weeks added. I understand that I will be charged a late fee in the amount of $5.00 if my payment is received after the 2nd day of the week. Furthermore, I give my permission for emergency treatment in the event that I/we the parent(s) or legal guardian(s) cannot be reached. I certify that I have read and completed the above information. I also understand that the registration fee and tuition are non-refundable. No refunds or substitutions for weeks missed. Please type name below as parent/legal guardian.
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