Relax Kids Registration Form

REGISTRATION FORM

2023-2024
Please check all that apply*

Current StudentSibling of Current StudentAlumni (someone in the immediate family attended Unity Preschool)New Preschool Family
Registration for New Families:

All registration forms received by Monday, January 23 will be randomly pulled to fill classes. Registration forms are NOT ranked by the order they are received. Placements will be announced via email the week of January 23. If your child is placed, you have 48 hours to pay the non-refundable registration fee ($125 - Twos and Threes classes; $150 - Fours classes) and return the Tuition Authorization Form to secure your child's placement.
Preschool Class Options

*Older Twos Class: Your child should be turning 3 between September 1st and February 1st and be "practically" potty trained (occasional accidents). *Threes and Fours Classes: Your child should be 3 or 4 years old by September 1st and be potty-trained.
I am interested in the following class:*

Older Twos Class T/W/Th 9:00 to 12:00 $225/monthThrees Class T/W/Th 9:00 to 12:00 $225/monthFours Class M/T/W/Th 9:00 to 12:15 $275/month
Student Information
Child's Name *

First NameLast Name
Preferred name they will use at Preschool
Birth Date*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Additional Email
example@example.com
Previous Preschool/Mother's Morning Out Experience (if any)
Does your child have any food allergies or dietary restrictions that we should know about?*

YesNo
If “Yes”, please provide more detailed information:
Does your child have any medical issues that we should know about?*

YesNo
Has your child ever been screened for developmental delays or received special services (ex., Baby Net, OT, PT, Speech, etc.)?*

YesNo
Do you have any developmental or behavioral concerns for your child?*

YesNo
If “Yes” to any of the above, please provide more detailed information:
For the safety of our students, staff and volunteers, we require that all immunizations required by the State of South Carolina for school attendance be current. An up-to-date immunization form must be on file with Unity Preschool prior to your child’s start date. The only exemption to this requirement that we offer is if you have a signed note from your child's doctor indicating that immunizations are delayed due to health issues. We do not recognize a religious exemption. Are your child’s immunizations current?*

YesNo
If your child's immunizations will NOT be current by the beginning of the school year, please provide more detailed information.
Please use this space to list any concerns, fears, dislikes or additional information that you would like to share with us.
Family Information
Student lives with:*

MotherFatherBoth ParentsOther
If student lives with an "Other", please explain.
Parent/Guardian - 1 Name*

First NameLast Name
Parent/Guardian - 1 Phone Number*

Area CodePhone Number
Parent/Guardian - 2 Name

First NameLast Name
Parent/Guardian - 2 Phone Number

Area CodePhone Number
Church that you attend (if any):
Names and ages of siblings living in household:
Emergency Contact Information
Emergency Contact: Provide the information of the person who would assume responsibility for your child in an emergency if Unity Preschool is unable to contact parents. *

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Relationship*
Child Pick Up Authorization: Please list the people authorized to pick up your child other than Parents and Emergency Contact. Your child will NOT be released to anyone other than parents/legal guardians, those listed below, or someone you contact us about who has your car tag or proper ID.
Please include Name, Relationship to Child, and Phone Number
Is there a court order preventing anyone from picking up your child? (If a court order exists, Unity Preschool will need to be provided with a copy to keep on file).*

YesNo
Authorizations and Releases

Please note: The Photo Release allows us to post your child's image on the SeeSaw class app that our teachers use, in our monthly Unity Preschool Newsletter, and occasionally in the Unity Church Newsletter. Unity Preschool does not use any other social media and will not include any names when posting images.
TERMS AND CONDITIONS: I understand that my child's registration is not complete until Unity Preschool receives the registration fee ($125 - Twos and Threes classes; $150 - Fours class), completed Tuition Authorization form, and immunization record. I understand that the registration fee is non-refundable and will be forfeited if I withdraw my child for any reason. I understand that our tuition must be paid by bank auto-draft and that our first tuition payment is due August 1st or upon enrollment and is non-refundable. I understand that the August 1st tuition payment will post as our last month’s payment and will be forfeited if I withdraw my child before the end of the school year for any reason.

I understand and agree that Unity Preschool and Unity Presbyterian Church and staff are released from all claims of financial responsibility arising out of any accident that may occur in connection with the operations of the Preschool or from illness that may be contracted by my child during the period of enrollment. If the parent/legal guardian is unable to be reached in an emergency, Unity Preschool staff has my permission to obtain medical treatment for my child. I understand that I am responsible for any financial expenses that may incur.

Unity Preschool does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational and admissions policies and scholarship or other school-administered programs.
PHOTO RELEASE: Unity Presbyterian Church (“Unity”) may from time to time post or publish information and images regarding its members and attendees on its website and in other publications and media pertaining to school, religious education, Youth Ministry, children’s choir and other Unity activities. The purpose of using this information is to promote, and inform members and Church attendees about the activities of Unity. Photos, videos and other media and images of Unity’s members and attendees may be used to accomplish this goal.

Unity’s website is accessible to anyone who is connected to the internet with a web browser. It is the policy of Unity that all photos, videos and other media or images posted or used by Unity will first be approved by a designated Unity employee and the last names of minor children will not be identified in these photos, videos or other media.

AUTHORIZATION TO USE AND RELEASE: I authorize Unity Presbyterian Church, on behalf of myself and my minor child and my heirs, executors and personal representatives, to use without compensation photos, videos and other Images of me and my minor child (the “Images”) on or in its website, videos, publications and other media used by Unity (the Unity “Media”) and to use my name and the names of my minor children in Unity Media except as limited above.

I hereby release Unity Presbyterian Church and its staff, officers and members, on behalf of myself and the minor child and my heirs, executors and personal representatives, from any claims arising out of its use of the Images of me and my minor child in Unity Media and I waive any rights I may have in the Images including the right of privacy and right of publicity.

This authorization to use and release will continue in effect until I notify Unity in writing of its termination and shall continue in effect with respect to any use of the Images prior to the effective date of termination.

I confirm that I am the parent or legal guardian of the minor child and that I have full authority to authorize Unity Presbyterian Church to use their Images and names without compensation.
Signature (click mouse in box and hold to use the dot to sign your name)
Date

MonthDayYear
Date
FOR OFFICE USE ONLY:

Registration Payment ReceivedTuition Authorization Form ReceivedImmunization Record Received
Should be Empty:

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REGISTRATION FORM

Registration for New Families:

Preschool Class Options

Student Information

Family Information

Emergency Contact Information

Authorizations and Releases