Mother Goose Playschool Registration Form

Please Select your Preferred Session*

4yr Monday/Wednesday 9-12pm (65.00/month)4yr Monday to Thursday 9-12pm (230.00/month)3yr Tuesday/Thursday 9-12pm (65.00/month)

Student's Name*

Student's Gender*

MaleFemale

Student's Birthday*

Parent(s) Name(s) 1:*

Parent(s) Name(s) 2:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

Contact Number*

Do you receive Text at this number?*

YesNo

2nd Contact Number*

Do you receive Text at this number?*

YesNo

Name 1:

First NameLast Name

Name 2:

First NameLast Name

Name 3:

First NameLast Name

Name 4:

First NameLast Name

Name 1:

First NameLast Name

Phone Number

Area CodePhone Number

Name 2:

First NameLast Name

Phone Number

Area CodePhone Number

Name 3:

First NameLast Name

Phone Number

Area CodePhone Number

Please click yes if you WILL give permission to have photographs of your child taken*

YesNoOnly for my personal update/emails etc.

Your signature (parent/guardian) will indicate approval for the above named child to:

1. Receive a class list including your child's personal information.

2. Be photographed by the media, approved community organizations, and Mother Goose Playschool staff and parents.

3. Be interviewed by the media, approved community organizations, and Mother Goose Playschool.

4. Have student work displayed, recognized, or reproduced inside and outside of the playschool. Information relating to this student's work will be communicated to the home in advance if outside of playschool.

5. Photo's of our day to day activities and field trips posted to our Facebook Page(s).

Signature

Immunization are up-to-date?

YESNO

Is your child on long-term medications?

YESNO

Does your child have any Drug Allergies?

YESNO

Does your child have any Food Allergies?

YESNO

Does you child have Special Needs?

YESNO

Is your child prone to any of the following?

If you have answered YES to any of the above; Please provide more info.

In the event of an emergency, when my child may need first aid or transportation to a medical facility, I give my permission for first aid to be given or for such transportation to take place.

Signature

PLAYSCHOOL FEES

The registration fee is required at the time of registration and is non-refundable. The registration fee for ALL students, regardless of the number of days per week they attend Playschool is $100.00. Post-dated tuition cheques payable to Lacombe Mother Goose Playschool are due at the Annual General Meeting.

NSF Cheques:

There is an additional fee of $20.00 for each dishonored cheque. Payment must be received directly by the Treasurer within five days of notification. After two NSF cheques, a child’s enrollment could be jeopardized.

No child will be registered if there are unpaid fees relating to the attendance of a previous sibling. Registration shall only be accepted after the past due account has been paid and the registering child’s fees have been paid in full (cash only).

WITHDRAWING CHILDREN

Notice to withdraw your child from Playschool must be provided in writing to the Director.

Any child who withdraws before the first of the month will be refunded all subsequent month’s tuition. If a child is withdrawn before the middle of the month you will be refunded one half of the monthly tuition and all subsequent months remaining. If the withdrawal occurs past the middle of the month, none of the current month’s fee will be refunded, only the subsequent month’s remaining.

I have received and read the Discipline Policy (page 3 of the Parent Handbook) of the program.

Signature

How did you find us?*

If you were referred by a friend please let us know who, so we can thank them!

My Products

Registration Fee (ALL Students)$100.00CAD

Required to complete Registration

Quantity

One Time Payment (2 Day Program) $650.00CAD

3yr and 4yr

First and Last Monthly Payments (2 Day Program)$130.00CAD

3yr and 4yr

First and Last Monthly Payments (4 Day Program)$460.00CAD

4yr program only

Total $0.00CAD

E-Transfers to be sent to lmgoose@telus.net please. Please provide Childs LAST NAME in memo.

Mother Goose Playschool Registration Form

Child pick-up Authorization:

Emergency Contact Information:

Medical Information