Running Start Preschool Registration
2024-2025
Student Information
Full Name
Date of Birth
Which class would you prefer?
Please add my preschooler to the M/W (9-11 AM) class.
Please add my preschooler to the T/Th (9-11 AM) class.
We are fine with either option.
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.
Child lives with
Both Parents
Dad
Mom
Other
If Other, please list name and relationship.
Name(s) & Age(s) of siblings (write N/A if none)
My child's strongest character traits:
My child enjoys this activity the most:
To encourage good behavior we:
To discourage inappropriate behavior we:
Tell me more about your child:
Medical or Developmental Issues (allergies, hearing, eyesight, behavior, attention deficit, etc.) (write N/A if none)
My child has been in a preschool environment previously:
yes
no
Mother's Information
Name
Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer & Occupation
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Father's Information
Name
Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer & Occupation
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Authorizations & Releases
Emergency Contact Information: * In the absence of parents, child can be released to:
List up to 2 contacts other than parents (Name, Relationship to Child and Phone Number)
Child Pick up Authorization: * other than Parents & Emergency Contacts
List up to 3 contacts other than parents (Name, Relationship to Child and Phone Number)
I understand that:
I authorize Carissa Stewart to provide medical treatment for emergency care at the nearest medical facility without delay. I/We assume full responsibility for the cost of any medical treatment.
My child has my permission to participate in outside play time in Carissa Stewart’s yard. Supervision will be maintained at all times.
I authorize Carissa Stewart to provide transportation in her vehicle when necessary. It is understood that standard safety practices will be used (car seats, seat belts, etc.)
I will not bring claims against Carissa Stewart or Running Start Preschool as a result of any injury suffered on or off the premises.
Field trip authorization: I give permission for my child to attend field trips.
Parent/Guardian Signature
First Name
Last Name
Signature Date
-
Month
-
Day
Year
Submit
Should be Empty: