Office Use: Crib Mon. ____ Wed. ____ Both: _____ Toddler MWF ____ T/Th ____ Young 2’s MWF ____ T/Th ____ Middle 2’s MWF ____ T/Th ____ Older 2’s MWF ____ T/Th ____ Younger 3’s MWF ____ T/Th ____ *Middle 3’s MWF ____ T/Th ____ *Older 3’s MWF ____ T/Th ____ *Young 4’s MWF ____ T/Th ____ Pre K 4’s MWF ____ T/Th ____ *Children must be potty trained to enter these classes.
I agree to pay a one-time activity fee of $100 per child payable at the time of application. This fee will not be refunded or applied toward tuition.
I understand that the first month’s tuition payment will be due the week of March 1, 2021 and will be nonrefundable.
If the application is processed after March 5, 2021, the first month’s tuition is due at the time of application.
I understand that tuition is due one month in advance at the first of each month.
If the fee is not paid on or before the due date, the child may be dismissed from the school and a replacement registered in the child’s place. If I experience financial difficulties that impair my ability to make tuition payments, I will contact the director to make payment arrangements.
I understand that if I enroll my child during the school year, the first month’s tuition is NON-REFUNDABLE.
If I tender a check to Asbury Preschool that is not honored by my bank, I agree to pay a $35 service charge on the returned check.
I understand that Asbury Preschool has certain fixed expenses that continue whether my child attends or not. If I find it necessary to drop out of Asbury Preschool during the year, I will give written notice two weeks in advance. I will be reimbursed for the days after notification.
I understand that Asbury Preschool reserves the right to dismiss my child at any time for disruptive behavior.
I understand that Asbury Preschool reserves the right to vary the schedule according to its individual needs and that refunds will not be given for unforeseen school closings.
I understand that Asbury Preschool will not accept my child if my child has green nasal discharge, diarrhea, or has had a fever or other symptoms of contagious disease or illness within the past 24 hours. If my child has had any of these, I am to notify Asbury Preschool and not return my child to school until all danger of contagion is past and he/she has been fever-free for a full 24 hours.
I understand that it may be necessary for my child to receive emergency medical care, and I will execute an authorization form for emergency care for my child and that my child will not be admitted to Asbury Preschool until the form has been signed and returned.
I understand that no medication will be administered by any member of the Asbury Preschool staff; except as provided for in our medication consent form.
*AUTHORIZATION FOR EMERGENCY CARE TO MINOR
I/We the undersigned, parent(s) or legal guardian of the minor listed below:
do hereby authorize any X-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any physician or dentist licensed by the State of Oklahoma and hospital service that may be rendered to said minor under the general, specific or special consent of:
(Name of adult person who is temporary custodian of minor)
The temporary custodian of the minor: whether such diagnosis or treatment is rendered at the office of the physician or dentist, or at the hospital licensed by the State of Oklahoma. I/We authorize the physician or dentist to call in any necessary consultants, in his/their discretion. We further authorize said physician or dentist to exercise his/their discretion in authorizing the disposal of severed tissues or member.
It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage those persons who have temporary custody of the minor, and said physician or dentist to exercise his/their best judgment as to the requirements of such diagnosis or medical or dental or surgical treatment. I/We authorize Asbury Weekday Preschool to transport the above-named minor to any medical facility and/or call my family physician.
This consent shall remain effective until 6:00 pm on the 31st day of May 2021, unless sooner revoked in writing, delivered to said physician or dentist or said persons entrusted with the custody, care and control of said minor child or children.
I/We understand and give consent for Asbury UMC to take and/or use photographs, voice, video or digital tapes of myself and/or my child(ren) for advertising or public display.