Preschool Registration

Room to Bloom Preschool Registration Forms
Thank you for trusting Room to Bloom Preschool with the care and education of your child!

Please fill out all enrollment forms below, making sure to sign and date them.

After your enrollment fee ($40) and monthly tuition fees are paid, your child
may begin preschool! If your child begins mid-month, partial payment is allowed based on the remaining days of the month that they will be attending.

A current Health Statement (signed by your child's health care provider) and immunization record is a requirement for all students.

Classroom visits/meet the teacher visits are held a few weeks before school begins in August. If you'd prefer to meet before then, please let me know.

Thank you,

Tiffany

Owner/Teacher

Room to Bloom Preschool
Class Options
2024/2025 School Year

(Wednesday, August 14th, 2024-Thursday, May 22nd, 2025)

Class Times and Days:

AM Class (for first time preschoolers)- 8:20am-10:50am (T/W/Th) - for children who will be 3 or 4 by October 1st, 2024 ($295 per month for 3 year olds and free for 4 year olds with Universal Pre-K enrollment)

and

PM Class- 11:10am-2:30pm (T/W/Th) - for children who will be 4 by October 1st, 2024 (Free with Universal Pre-K enrollment)

Summer 2025

(Tuesday, June 3rd- Thursday, July 31st)

Children must be 3 years old and fully potty trained upon enrollment.

Class Time and Days:

9am-12:00pm (T/W/Th) ($300 per month)

2025/2026 School Year

(Wednesday, August 13th, 2025- Thursday, May 21st, 2026)

AM students must be 3 years old upon enrollment.

UPK students must be 4 by October 1st, 2025.

All children need to be potty trained upon enrollment.

Class Times and Days:

3 Year Old Program: Tuesday/Thursday (815-1115am), $250 per month

4 Year Old UPK Program: T/W/Th (1135am-2:55pm), No cost with UPK enrollment
Preschool Registration
Expected Start Date

MonthDayYear
Date
Which class/es are you wanting to register for?*
Student Information
Name*

First NameLast Name
What name does your child prefer to be called?*
If your child goes by a shortened name or nickname: Would you like them to learn how to write their shortened name/nickname, their full name, or both?
Gender at Birth*

FemaleMale
Birth Date*

MonthDayYear
Home Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Language Spoken at Home*
For English language learners: Please describe your child's level of fluency in speaking English.
Parent/Guardian Information 1
Full Name*

First NameLast Name
Cell*

Area CodePhone Number
Work

Area CodePhone Number
Employer Name*
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Address - Same As Child*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information 2
Full Name

First NameLast Name
Cell

Area CodePhone Number
Work

Area CodePhone Number
Employer Name*
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Address - Same As Childs

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Health Information
Health Care Provider's Name*

First NameLast Name
Health Care Provider's Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your child immunized?*

YesNo
Does your child have any dietary, drug or environmental allergies?*

YesNo
If yes, please list.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications. Pain or fever reducing medications will not be administered at school.
Please list the people authorized to pick up your child in the event of an emergency.
Emergency Contact - Other than Parent/Guardian
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell*

Area CodePhone Number
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Cell*

Area CodePhone Number
Child Profile
Do you have any concerns about your child’s development?
What goals do you have for your child over the next year?
Is your child eager to try new foods? What is their favorite food?
Does your child have any specific fears (loudnoises, animals etc.)?
Describe your child’s temperament.
Are there any activities you prefer that your child NOT participate in?
Please list any concerns or comments you would like to share about the care and education of your child.
Annual Authorization Forms
EMERGENCY MEDICAL CARE AND TRANSPORTATION

I hereby give my permission for the staff at Room to Bloom Preschool to call a doctor or emergency medical service and for the doctor, hospital or medical service to provide emergency medical or surgical care for my child. It is understood that the preschool staff will make a conscientious effort to locate the parent/guardians and emergency contacts listed on the registration document before any action will be taken. If it is not possible to locate the emergency contacts listed, treatment will not be delayed. Your child will be transferred to the hospital that the medical professionals deem most appropriate for your child’s circumstance. By signing below you agree to accept the expense of emergency transportation, medical and/or surgical treatment.
Signature*

Clear
Date*

MonthDayYear
Date
SUNSCREEN

Parents are expected to apply sunscreen to their child before school. Sunscreen is available for you to use. If we go outdoors more than 2 hours after the start of class, I will apply sunscreen (SPF 30 or higher) to your child.

I give my permission for the staff at Room to Bloom to assist with applying or apply sunscreen to my child's exposed skin including the face, tops of ears and bare shoulders, arms, legs and feet before outdoor activities. Sunscreen will not be applied to any broken skin or if a skin reaction has been observed. Any skin reaction observed by staff will be reported promptly to the parent/guardian.
Signature*

Clear
Date*

MonthDayYear
Date
PHOTOGRAPH RELEASE FORM

I hereby give consent for photographs of my child to be sent electronically via e-mail and/or cell phone picture messaging to the parents/guardians of the child listed above. Photos of children may be posted on our Facebook page (from the neck down).
Signature

Clear
Date*

MonthDayYear
Date
ANNUAL WELL CHILD CHECK UP AND IMMUNIZATION RECORD

I understand that it is my responsibility to ensure that my child receives a well child checkup with their health care provider every 12 months (or more often if indicated by their provider). After this appointment, a signed statement of health and current immunization record must be brought to school. According to Colorado law, children who do not have these forms completed in a timely manner each year must not attend school.
Signature*

Clear
Date*

MonthDayYear
Date
CHILDREN WITH ASTHMA, ALLERGY AND/OR OTHER HEALTH PLANS

If your child has a health plan for asthma, allergies or another health condition, please bring in an updated plan with your health care providers signature every 12 months. In order for me to dispense prescribed rescue medications, the medicine must be brought to school inside its original pharmacy box. It is your responsibility to make sure that the medication is not expired. Licensing rules do not permit me to dispense expired medication. Your signature below confirms that you understand and will comply with the policies regarding health plans and rescue medication administration.
Signature*

Clear
Date*

MonthDayYear
Date
Parent-Provider Agreement
This agreement is between Parent/Guardian Full Name * and Tiffany Bauer (DBA Room to Bloom Preschool).
Child Name*

First NameLast Name
Child Date of Birth*

MonthDayYear
Date
Standard Rates and Discounted Days

A non-refundable enrollment fee of $40 is required for new students. A non-refundable deposit of $40 per family is required if a spot is to be held over the summer. Deposits will be applied to the August tuition fee. Tuition is due on the 1st of each month (including August, despite the later start date), with the grace period extending through the 5th.

Holidays, Substitute Care and Overtime

Our schedule of breaks is typically posted online by August each school year. Generally speaking, we have a two week long summer break in August and one week long breaks for Thanksgiving (November), winter break (December) and spring break (March or April). We are also closed on New Year’s Day, Memorial Day, Independence Day, and Labor Day. Additional planned closures are unlikely, but may occur with two weeks notice. Tuition rates are the same each month regardless of school closures or absences.

In the rare case that the provider is ill or must be away for an appointment, a substitute will NOT be available. Parents will receive a refund of $15 per day if there are more than four unscheduled closures during the school year (unless the closure is weather related).

There will be a late charge incurred at the rate of $1 per minute if parents habitually arrive later than 5 minutes after their scheduled pick up time. A $10.00 per day late payment fee is assessed if your tuition payment is not made on or before the 5th of each month.

Termination Procedure

This agreement begins on the date of enrollment and may be terminated by the provider or parent/guardian by giving two weeks notice. The provider may terminate the agreement without notice if the parent/guardian has not made payment after the 10th of the month.

Meet the Teacher

If you are registering before a school tour has taken place, plan on scheduling a classroom visit sometime before your child's first day. This meeting is a licensing requirement and it will help your child become familiar with the new environment. It is also a great way for us to get to know each other!

Signatures

In signing this document, all parties agree to all of the above policies and terms, including financial responsibility for tuition. Your signature also confirms that you have read and will comply with the Policies and Procedures as outlined in the handbook. Copies of this signed agreement are available upon request.
Signature*

Clear
Date*

MonthDayYear
Date
Enrollment Fee
prevnext( X )
Enrollment Fee$40.00
You can pay the $40 enrollment fee through PayPal, or with Zelle using the phone number (720) 304-5953. Please note that tuition payments must only be paid with Zelle, cash, or check.

Total $0.00
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Room to Bloom Preschool Registration Forms

Class Options

Preschool Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Health Information

Emergency Contact - Other than Parent/Guardian

Emergency Contact - Other than Parent/Guardian

Child Profile

Annual Authorization Forms

Parent-Provider Agreement

Enrollment Fee