Application for Enrollment

Application for Enrollment

NON-REFUNDABLE registration fee of $100 per family is due at time of enrollment. This can be mailed in or dropped off at the office. St. Christopher's Episcopal Preschool 2800 Trimmier Rd. Killeen, TX 76542
Registration for:

School year 2020/2021
Student Name

First Name Middle Name Last Name
NICKNAME:
Date of birth:

Month Day Year
Date
Age: (as of Sept. 1, 2020)
Gender:
ARE THERE ANY ALLERGIES, SPECIAL FOOD CONSIDERATIONS, OR MEDICAL CONDITIONS? Please be specific.
Please list:
Parent Name:

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
Employer:
Parent Name:

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
Employer:
Signature:

Clear
YOUR DOB:

Month Day Year
Date

***EMERGENCY INFORMATION***

In the event parents/guardians are not available, I authorize the school to contact or release my child to the following people: This information is required by the state of Texas. YOUR EMERGENCY CONTACTS CANNOT BE LISTED UNDER PARENT INFORMATION AND MUST BE WITHIN 25 MILES.
1. Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
2. Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
3. Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
****************************************************
Name of Physician

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I AUTHORIZE ST. CHRISTOPHER'S EPISCOPAL PRESCHOOL TO OBTAIN MEDICAL CARE AND TO TRANSPORT MY CHILD FOR EMERGENCY MEDICAL TREATMENT:
PLEASE REMEMBER TO KEEP ALL EMERGENCY INFORMATION CURRENT.
Are you interested in the before or after school program?
Comments:
SIGNATURE:

Clear
Today's Date

Month Day Year
Date
Should be Empty:

***EMERGENCY INFORMATION***