Blooming buds preschool registration and wavier form

Blooming buds Preschool

Registration form
Jenni Hansen

152 East 200 South Smithfield

435-512-9018
Child's Name?*
Child's gender*

FemaleMale
Child's age*
Child's birthday*

MonthDayYear
Date
Your child's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's name*

First NameLast Name
Father's email*
example@example.com
Father's phone number*
Please enter a valid phone number.
Mother's name*

First NameLast Name
Mother's email*
example@example.com
Mother's phone number*
Please enter a valid phone number.
Student lives with:*
List any custody agreements I need to know about. If no legal documents are provided, I cannot deny access or release of the student to either parent.
Emergency Contact info:
Doctor and phone number:*
Hospital preference:*
If I cannot get a hold of a parent(s)/guardian(s), who can i contact in the event of an emergency? Please put their name and number.*
Medical:
Does your child suffer from any allergies, if so please explain?
Dietary restrictions:
Medical concerns:
Vision concerns:
Speech concerns:
Special fears I need to know about:
Any other concerns I need to know about:
Has your child been recommended for any testing? if yes, please explain.
About your child
Special interests and activities*
Favorite color?*
Brothers/sisters?
Briefly describe your child's personality:*
Anything else I need to know about your child?*
Enrollment
Please check which class your child will be attending, please mark which one we agreed to:*

morning class: Monday/Wednesdays, from 9am-11am
- Please note that there is a $35 non-refundable registration fee, which is due at the time of signing up to secure your child's spot.
- Class starts after labor day and goes until the middle of May.
- Please note we will have snack time each day, your student will be in a class rotation on who brings the snack for the class. When it's your child's turn to bring the snack, they will bring it for all their classmates that week.
- I use an app called GroupMe, and I send all info through that app, so please download it.
- I get 5 emergency/family/personal leave days throughout the school year if needed. I also follow the cache county school district, so their days off we will also have off.
- Starting Jan 1st, 2026, if you need to pull your student out of preschool, the rest of the school year tuition will still need to be paid.
- I offer cash, check, and Venmo (Jenni-Hansen), and as long as you do it as a family and friends transaction and not as goods and services, so I do not get charged the fee, if you pay with the fee on Venmo, you will be in charge of covering that fee. and if you want to pay using a card, a 4% fee will be added.
- Tuition is $80 a month and payments are due by the 10th of each month, after the 10th a $10 late fee will be added on for each week your payment is late. As of right now, I do not accept payments made in full, the only option is monthy payments.
By signing and/or typing my name below, I agree that I have read and agree to the conditions of blooming buds preschool stated on this form:*

First NameLast Name
Signature*

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Waiver and Release of Liability

Blooming buds preschool
Child's name*

First NameLast Name
I First Name* Last Name* agree that this Waiver and Release of Liability shall apply to me, my child, or any other family member each day he/she is at Blooming Buds Preschool, starting on the date signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, damages, expenses, or deaths that might occur to me, my child, or other family members while on the premises of the school or participating in any off-sight preschool program or activity; and to the maximum extent of the law. I agree to waive and release any and all claims, suits, or related causes of action against Blooming Buds Preschool, their owners, officers, employees, volunteers, or agents for injury, loss, death, cost/expenses, or other damages to me, my heirs or assigns, or third party claims, suits or related causes of action asserted against the preschool arising from my conduct and/or my family’s conduct while participating in the preschool’s programs or activities. I further agree to release, indemnify, defend and hold Blooming Buds Preschool and all owners, employees, volunteers, or agents, harmless from any liability whatsoever for future claims presented by me, my child, other family members, or third party people, for any injuries, losses, damages, or any Covid-19 related illness or incident.

By signing and/or typing my name below, I agree I have read, agreed, and understood this agreement and conditions stated in this form, and am aware that by signing this agreement, I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and assigns may have against Blooming Buds Preschool, its owners, employees, volunteers, and family members.

First Name* Last Name*

Date*
Signature*

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Medical Release

blooming buds preschool
Child's Name*

First NameLast Name
I   First Name*   Last Name*   hereby consent that I, my child, family members, or third party people to emergency medical, and/or hospital services that may be rendered by blooming buds staff, family, volunteers, EMTs, hospital, nurses, physicians, and/or doctors, in the event such need arises while at or on the premises of Blooming Buds Preschool.

By signing and/or typing my name below, I have read, agreed, and understood this agreement and conditions stated in this form, and am aware that by signing this agreement, I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and assigns may have against Blooming Buds Preschool, its owners, employees, volunteers, and family members.

First Name*   Last Name*

Date*
Signature*

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Permission to photograph and video

blooming buds preschool
Child's Name*

First NameLast Name
I   First Name*   Last Name*   , hereby authorize Blooming Buds Preschool, owners, employees, and volunteers to photograph and/or video my child, in the school setting and off-campus school-related activities. I give permission for my child’s photos and videos to be posted in the Blooming Buds Preschool newsletter, yearbook, the Blooming Buds Preschool website, Facebook page, Instagram, Twitter, and for all advertising purposes Blooming Buds Preschool its owners and employees use for advertisement purposes. Photos will not be sold or given to private parties.

By signing and/or typing my name below I agree I have read and agree to the terms and conditions stated in this form.

First Name*   Last Name*

Date*
Signature*

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Should be Empty:

Blooming buds Preschool

Emergency Contact info:

Medical:

About your child

Enrollment

Waiver and Release of Liability

Medical Release

Permission to photograph and video