2024-25 Enrollment Application

Family Information

First Parent
First Parent Info:

First NameLast Name
Cell Phone
Please enter a valid phone number.
Cell Carrier
Work Phone
Please enter a valid phone number.
Email
example@example.com
Employer Name
Employer Address
Church Membership

Family Information (Cont'd)

Second Parent
Second Parent Info:

First NameLast Name
Cell Phone
Please enter a valid phone number.
Cell Carrier
Work Phone
Please enter a valid phone number.
Email
example@example.com
Employer Name
Employer Address

REGISTRATION GUIDELINES
& ACKNOWLEDGEMENT
1. The $200 registration fee is nonrefundable. $150 semi-annual supplies fees will be added to your bill in Sept and January.
2. An immunization certificate showing your child is current with all vaccinations is required by DHEC on the first day of school. Immunizations must be kept current throughout the school year, or we are required to ask you to withdraw your child.
3. I give St. Martin’s Preschool permission to photograph and post pictures of my child in the classroom on St. Martin’s social media accounts and/or website and/or publications.
Checking the box below signifies that you have read and understand the above Registration Guidelines & Acknowledgement*

Emergency & Medical Information
Emergency Contacts: If parents cannot be located, in case of illness or accident, notify:

	Name	Relationship	Phone
Contact 1
Contact 2

If medical assistance is required, it is requested that the following physician or dentist be notified:
Physician
Phone
Address
Health Insurance Provider
ID/Group
Dentist
Phone
Address

Allergies & Medical Information
List any known allergy your child has
Medical Treatment Release
I give permission for medical treatment of my child, {fullName}, by a doctor and/or hospital in case of an emergency when neither parent(s) nor person(s) listed as emergency contacts can be reached.

I hereby authorize the director or assistant director of St. Martin’s Preschool to execute any and all documents including any necessary releases on my behalf, which might be required, by any medical facility or physician to perform any emergency care, on account of any accident or illness sustained or incurred by my child, named above, while attending St. Martin’s Preschool.

I further agree that in consideration of my child's attending St. Martin’s Preschool, I will hold St. Martin’s Preschool, and its agents and servants, harmless from any action by me or my child on account of any injury or damage sustained or suffered by my child while attending St. Martin’s Preschool or field trips.

I certify that my child, named above, is in good health and requires no special medical care or treatment while at St. Martin’s Preschool.

By entering my name below in the signature field below, I authorize the above release.
Parent's Signature
Date

MonthDayYear
Date

Relatives/Sitters who have permission to pick my child up

	Name	Phone
1.
2.
3.

Should be Empty: