Mighty Oaks Registration 2024

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Child's #1 Name (Nombre del primer estudiante)* This field is required.

First Name

Middle Name

Last Name

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Child #1 What grade will your child be in for the 24- 25 school year? (Cual grado va ha entrar en el año escolar 24-25 el primer estudiante?)* This field is required.

TK

K

1st

2nd

3rd

4th

5th

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Child #1 Birth Date (Fecha de Nacimiento para el primer estudiante)* This field is required.

4

Child #1 Gender (Género del primer estudiante)* This field is required.

5

Child # 2 Name (Nombre del segundo estudiante)

First Name

Last Name

7

Child #2 Birth Date (Fecha de nacimiento del segundo estudiante)* This field is required.

8

Child #2 Gender (Genero del segundo estudiante) * This field is required.

9

Parent #1 Name (Nombre de padres)* This field is required.

First Name

Last Name

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Parent #2 Name (Nombre de padres)

First Name

Last Name

11

Address (Direccion)* This field is required.

Street Address

City

State

Zip Code

Country

12

Primary E-mail (Correo electrónico primario)* This field is required.

example@example.com

13

Secondary E-mail (Correo electrónico secundario)

(optional)

14

Parent #1 Primary Phone Number (Numero de telefono de primer padre)* This field is required.

15

Parent #2 Primary Phone Number (Numero de telefono de padres)* This field is required.

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Emergency contact person #1(Nombre de persona en caso de emergencia #1) First Name *     Last Name *
Phone number #1(Numero de telefono) *
Relationship to the child( Relacion ha estudiante)   *
Emergency Contact person #2(Nombre de persona en caso de emergencia #2)    First Name *     Last Name *
Phone number #2 (Numero de telefono) *
Relationship to the child (Relacion ha estudiante)   *
Authorized pick up person name/ relationship to child (Nombre de persona que puede recojer ha el estudiante y relacion)   First Name *     Last Name *
Authorized pick up person name/relationship to child (Nombre de persona que puede recojer ha el estudiante y relacion)   First Name *     Last Name *

17

Child #1 Preferred Care Schedule (Horario preferido)* This field is required.

18

Child #1 Please select which days you would like your child to attend. (Por Favor de escoger los dias de la semana que gustaria el estudiante que asiste)* This field is required.

Monday (Lunes)

Tuesday (Martes)

Wednesday (Miercoles)

Thursday (Jueves)

Friday (Viernes)

19

Child # 2 Preferred Care Schedule (Horario preferido)* This field is required.

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Child #2 Please select which days you would like your child to attend. (Por Favor de escoger los dias de la semana que gustaria el estudiante que asiste)* This field is required.

Monday (Lunes)

Tuesday (Martes)

Wednesday (Miercoles)

Thursday (Jueves)

Friday (Viernes)

21

Please list any medical needs or conditions that should be known to staff. (allergies, dietary needs, ...) (Enumere cualquier necesidad o condición médica que el personal deba conocer. Alergias, necesidades dietéticas, ...)

22

Please initial next to the following.(Por favor ponga sus iniciales junto a lo siguiente) I understand that I will be charged a late fee of $1.00/minute for each minute that I am late and arrive after 5:45 pm to pick up my child. (Yo entiendo que me van ha cobrar un$1 por cada minuto que llegue
despues de las 5:45 pm.) I understand I will be charged $10 if I neglect to notify the director, at least one hour prior to dismissal, when my child will be absent on their scheduled day. (Yo entiendo que me cobraran $10 cada vez que no notifique ha la directora no mas tardar una hora antes que se acabe la escuela que mi estudiante no va ha attender ese dia.)    Signature *
Any changes to my child's schedule contract will be made two weeks in advance by notifying the Program Director in writing and subject to a $10 fee. (Cualquier cambio en el contracto de horario de mi hijo se realizara con dos semanas de anticipacion al Director del programa por escrito y sujeto a una tarifa de $10.)   Signature *
My signatures signifies a promise to pay the appropriate monthly amount on a timely basis. Payments are due the before the 5th business day of the each month. After the 5th day a $1/day late fee may be applied to my account. (Mis firmas significan una promesa de pagar la cantidad mensual apropiada de manera oportuna. Los pagos vencen antes del quinto dia de cada mes. Despues del quinto es posible que se aplique a mi cuenta un cargo por de retraso de $1 por dia.)     Signature *

23

24

Date (Fecha de hoy)

Date

25

By signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.(Al firmar a continuación, entrego una firma electrónica que tendrá el mismo efecto que una firma manual original en papel. La firma electrónica será tan vinculante como una firma manual original en papel.)* This field is required.

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