Preschool Registration Form

24/25 Preschool Registration Application

Rutland Parent Participation Preschool Society
Information of Child
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*

FemaleMale
Days of the week desired:*

MondayTuesdayWednesdayThursday
Rates Reminder:

2 days per week:$210 monthly commitment

3 days per week: $265 monthly commitment

4 days per week: $320 monthly commitment

We are currently enrolled in the ChildCare Fee Reduction Initiative which subsidizes a portion of the prices at RPPP.

The prices here reflect the price after that discount.
Information of Parent/Guardian 1
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Information of Parent/Guardian 2
Parent Guardian 2:*

Lives with Parent/Guardian 1Lives Elsewhere (Please complete address and contact info below)Not Applicable
Please upload any relevant custody orders that are currently in place.

This is compulsory and is for your child's protection and well-being.
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Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1
In the event of an emergency, please contact:
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Emergency Contact 2
In the event of an emergency, please contact:
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address
example@example.com
Other people authorized to pick up child from school
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Email Address
example@example.com
Medical Information
Doctor's Name*

First NameLast Name
Doctor's Phone Number*
Please enter a valid phone number.
Please list any of the following: Current medications, known/suspected allergies, special diet (for any reason - ie: kosher, vegan, halal, dairy free), medical diagnosis or concerns you wish to disclose:*
Is your child Potty trained?*

YesNoIn progressOther
Does your child require any extra support to integrate or participate safely?*
Child's Care-Card Number:*
Please do NOT leave blank
Please upload a photo of your child's Birth Certificate here*

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Please upload any immunization/vaccination records for your child here

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Please ensure you have read and downloaded this Handbook. Paper copies can be requested as well in class.
Please upload a photo of your child's face for our emergency files.

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I understand that this application is not a guarantee of acceptance. Once my application is confirmed, I will be notified. If there is space for my child, I agree to pay a non-refundable fee of $100. This can be done *AFTER CONFIRMATION* via Cash, Cheque, or EFT to rppptreasurer@gmail.com*

I understand and I will pay my registration fee after receiving confirmation
I have read and agree to follow the guidelines in the RPPP Family Handbook.*

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24/25 Preschool Registration Application

Information of Child

Information of Parent/Guardian 1

Information of Parent/Guardian 2

Medical Information