Registration Form
Please fill out all pages/sections completely.
Child's Full Name
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Nickname
Date of Birth
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Month
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Day
Year
Date
Sex
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Please Select
Male
Female
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Chronic Physical Problems/Pertinent Developmental Information/ Special Accommodiations Needed
Previous Child Day Care Programs and Schools Attended
If this child attends this center and another school/program, give the name of the school/program
Father's Full Name
Father's Place Employed
Father's Business Phone Number
Please enter a valid phone number.
Father's Cell Phone Number
Please enter a valid phone number.
Father's Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Home Phone Number
Please enter a valid phone number.
Mother's Full Name
Mother's Place of Employment
Mother's Business Phone Number
Please enter a valid phone number.
Mother's Cell Phone Number
Please enter a valid phone number.
Mother's Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Home Phone Number
Please enter a valid phone number.
Father's Email Address
Mother's Email Address
Person(s) or Agency Having Legal Custody of Child
Cell Phone Number
Please enter a valid phone number.
Person(s) or Agency Having Legal Custody of Child's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Allergies or Intolerance to Food, Medication, etc. and Action to take in an Emergency
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Child's Physician
*
Physician's Phone Number
*
Please enter a valid phone number.
Full Name of Emergency Contact #1 (To be contacted if parent(s) cannot be reached)
*
Emergency Contact #1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact #1 Phone Number
*
Please enter a valid phone number.
Full Name of Emergency Contact #2 (To be contacted if parent(s) cannot be reached)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact #2 Phone Number
*
Please enter a valid phone number.
Person(s) Authorized to Pick up Child
*
Person(s) NOT Authorized to Pick Up Child (Appropriate paperwork such as custody papers shall be provided if there are any restrictions on pick up)
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Parent or Guardian Signature
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Date
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Month
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Day
Year
Date
Last 4 digits of Parent or Guardian's Social Security #
*
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Service Agreement
We have reserved a place for your child to attend Little Angels.
Child's Name
First Name
Last Name
Number of Days a Week to Attend
Days of the Week
Monday
Tuesday
Wednesday
Thursday
Friday
Date Child will Start Attending
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Month
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Day
Year
Date
Weekly Tuition Amount
Full Time or Part Time
Full Time
Part Time
Agreement-
Tuition fees are due weekly. There is a $20 late fee for payments not paid on time. There are no reductions of fees for absences, school holidays or closings due to inclement weather. There is a late fee of $10 for the first five minutes then $1 per minute if picked up after 6:30pm (Full-Time) or 12:30pm (Part Time).
Full Time- Child's Full Name-
First Name
Last Name
Part Time- Child's Full Name
First Name
Last Name
Signature
*
Date
*
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Month
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Day
Year
Date
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Child's Emergency Medical Authorization
Child's Full Name
First Name
Last Name
Child's Date of Birth
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Month
-
Day
Year
Date
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Child's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Mother's Name
Mother's Cell Phone Number
Please enter a valid phone number.
Mother's Place of Employment
Mother's Business Phone
Please enter a valid phone number.
Mother's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Full Name
Father's Cell Phone Number
Please enter a valid phone number.
Father's Place of Employment
Father's Business Phone Number
Please enter a valid phone number.
Father's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agreement-
The Parent(s)/Guardian(s) authorize Little Angels Montessori Preschool to obtain immediate medical care and consents to the hospitalizations of, the performance of necessary diagnostic test upon, the use of surgery on, and/or the administration of drugs to/his/her child or ward if any emergency occurs when s/he cannot be located immediately. It is also understood that this agreement covers only those situations which are true emergencies and only when s/he cannot be reached. Otherwise, s/he expects to be notified immediately.
Treatment
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I will be responsible for the payment of medical care expenses
Medical treatment costs are covered by insurance
No insurance
Insurance Name
Insurance Policy Number
Child's Physician
Signature
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Date
*
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Month
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Day
Year
Date
Authorization for Emergency Treatment
Permission for the Director, Acting Director, or the teacher to take whatever steps may be necessary for medical care in case of an emergency is hereby given. I understand that the order of actions taken will follow the outline below unless there is need for more immediate action, but will not be limited to these actions: 1. Parent/Guardian Called 2. Child's Physician will be called 3. Emergency Contacts listed will be called 4. If none of these efforts are successful, another physician or ambulance may be called. Or the child will be taken to the emergency room of ___ accompanied by a staff member. 4. In order for the school to assume responsibility for my child, I understand that I must sign the child in at arrival and out at departure time.
Emergency Room Name in case of emergency
Signature
*
Date
*
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Month
-
Day
Year
Date
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Field Trip and Activities Permission Sheet
1. I give permission for my child to participate in the neighborhood walks or field trips in an authorized vehicle. I understand that I will be informed of all planned field trips that I may withdraw my permission for a planned trip if I so desire. 2. I grant permission for my child to be included in school pictures and give permission for those pictures to be used by the center.**This includes the use of pictures/videos on our website or on our social media sources. Pictures can also be uploaded to school app for viewing. 3. I grant permission for my child to participate in the activities and in the use of the equipment at the center. 4. I grant permission for my child to play at the public playground used by the center or grassy areas located on the property. 5. I grant permission for my child to play in a child’s wading pool that will not contain greater than six (6) inches of water.
Signature
*
Date
*
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Month
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Day
Year
Date
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Parent's Handbook Checklist
In order to assure that parents clearly understand the policies of the school, we ask all parents to read the Little Angels Parent’s Handbook thoroughly. Please sign below. 1. There is no reduction of fees for absences, designated school holidays, or closures due to inclement weather. 2. There will be a $30.00 charge for each returned check. After two returned checks, tuition must be paid in cash or card. 3. Parent, guardian, or responsible designated adult must sign the child in and out each day and must make sure the teacher knows when they arrive and leave each day. (Please be aware that we cannot assume responsibility of allowing any child to leave persons under 18 years of age.) 4. The child must be kept at home for 24 hours if any of the following exists: a temperature of 101 degrees or more, intestinal disturbances accompanied by diarrhea or vomiting, any undiagnosed rash, sore or discharging eyes, or ears, profuse nasal discharge or a child that is too sick to participate in the full program, including outdoor activities. 5. Parents or guardian must furnish 2 coverings for nap (sheet AND blanket), and a complete change of clothing at all times, with the child’s name on each item. 6. Parents or guardian must inform the school of changes in address, phone number, (work or home)employment, or emergency information. 7. Food may not be brought to school except in cases of allergies, religious beliefs or pre-approved celebrations. 8. Toys may not be brought to school except on show and tell day (Friday). 9. Tuition is due every Monday in advance and a $20.00 late fee will be assessed if not paid by Tuesday. 10. The director is to be notified two weeks in advance before a child is to be withdrawn. Parents are required to pay those two weeks regardless of when the child leaves school. 11. Parents or guardian agrees to dress the child in accordance with the school dress code. 12. If after reasonable period of time, it is found that a child is unable to adjust to the Center, the Center reserves the right to request withdrawal for the child. This decision is left to the discretion of the Director. 13. A late pickup fee of $10.00 per 5 minutes then $1.00 per minute after will be charged after closing time. The late-fees go directly to the teachers that had to stay late waiting on you to pick up your child. 14. If a child is to receive any medication during the school day, the parent or guardian must have completed a Medication Authorization form. Sunscreen/sun block lotion and insect repellent also requires a Medication Authorization form. 14. I agree to abide by these rules and regulations.15. I have received the Parents Handbook.
Signature
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Date
*
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Month
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Day
Year
Date
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Enrollment Checklist
1. Registration Forms Completely Filled out (No Blanks Please). 2. Updated Shot Record (upon entry) 3. School Physical Form signed by Physician (due within 30 days after entry). 4. Birth Certificate/Birth Letter or Proof of Identity. 5. Enroll and download Brightwheel App. 6. Crip Sheet and Blanket (naptime) 7. Change of Clothes (for accidents and spills). 8. School Supplies.
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