MDO Ready Steps Registration Form

Ready Steps Mother's Day Out Registration Form
Student's Name*
Last, First, Middle
Student's Birthday*

MonthDayYear
Month, Day, Year
Student's Gender*

MaleFemale
Mother/Guardian's Name*
Mother/Guardian's Contact Number*
Do you receive Text at this number?*

YesNo
Mother/Guardian's Alternate Number*
Father/Guardian's Name*
Father/Guardian's Contact Number*
Do you receive texts at this numb*

YesNo
Father/Guardian's Alternate Number*
Preferred Email Address*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name (other than parent/guardian)*
Emergency Contact Number*
Are texts received at this number?*

YesNo
Alternate Contact Name (other than parent/guardian)
Alternate Contact Number
Who (besides you) has permission to pick up your child?
Alternate Pick Up's Contact Number
Are texts received at this number?

YesNo
Doctor's Name:
Special information we should know about releasing your child:
Please note any allergies, special problems or feeding instructions:
If no, write "None"
Please Select your Preferred Session*

Fall Semester - $185.00/moSpring Semester - $185/moSummer Semester - $185/mo (Infant thru Pre-K)Summer Kids' Kamp - $100/mo (K thru 5th)
There is a $25 registration fee,

per family, due with the application.

This can be paid in person

or with the Pay Online Realm button on the right.

First month's tuition is also due at the time of registration.

**Tuition is due on or before the first school day

of each month. If payment is not received by the 15th day

of each month, an additional fee of $10 will be assessed
We occasionally take pictures

of the kids in action with the materials

or doing other activities for our website and/or blog.

We hope to use these to keep parents

up to date on the happenings at school.
Please click yes if you WILL give permission to have photographs of your child taken*

YesNoOnly for my personal update/emails etc.
How did you find us?*

SignFlyerGoogle/Other search engineFacebookFriendHometown ValuesOther
If you were referred by a friend please let us know who, so we can thank them!
Parent/Guardian's signature*

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Parent/Guardian's signature

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Date

MonthDayYear
Date
Should be Empty:

Ready Steps Mother's Day Out Registration Form