SSPDS Registration Form 2025-2026

SSPDS Registration Form 2025-2026

Please complete one form per family.
Name of Child(ren) (please list all children attending SSPDS)*
Parent/Guardian 1
Name*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-Mail Address*
example@example.com
Should this e-mail address be used for the weekly parent e-mail?*

YesNo
Parent/Guardian 2
Name
Phone Number
Mailing Address (if different than Parent 1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-Mail Address
example@example.com
Should this e-mail address be used for the weekly parent e-mail?

YesNo
Is there anyone else who will regularly drop off/pick up your child who should also receive the weekly e-mail? If so, please list their name and e-mail address.
Emergency Contact Information

If a parent/guardian is unable to be reached, please list persons to be contacted in the event of an emergency. Please also list anyone approved to pick up your child. Children will not be released to anyone other than those listed here or in Procare. (These people will be added to your child's Procare profile).
Emergency Contact 1: Name and Relationship (not a parent/guardian)*
Emergency Contact 1: Phone Number(s)*
Emergency Contact 2: Name and Relationship (not a parent/guardian)
Emergency Contact 2: Phone Number(s)
Personal Information & Photography Release
Class roster information to be shared with all families in the class:*

I do NOT want my child to be listed on the class roster AT ALL.I give permission for the following information to be included on the class roster (next question).
I give permission for the following information to be included on the class roster and shared with all families in the class:*

Child's NameChild's BirthdayChild's AddressParent Name(s)Phone NumberE-Mail AddressNone of the information above should be listed on the class roster
If selected above, please list the email address you want to be listed on the class roster.
example@example.com
If selected above, please list the phone number you want to be listed on the class roster.
Please enter a valid phone number.

By marking my preferences below, I give/do not give permission to St. Stephen Presbyterian Day School to take photographs or video of my child both in the classroom and at any Day School-sponsored activity, and that the Day School may use these photographs and/or videos for any legal purpose related to the internal or external promotional and informational activities. SSPDS and its agents will never identify a child by name in a publication, on a website, or social media platform.*

	I GIVE PERMISSION	I DO NOT GIVE PERMISSION
Private Class Facebook Page (only current families in the class)
Day School Social Media Pages (public)
Procare App (to all parents in the class)
Procare App (to parents only)
Day School Website
Printed Promotional Materials

Medical Information & Health Record

Please complete ONE PER CHILD. If you have another child enrolled at SSPDS, you will be prompted to complete an additional record.
Child's Name*
Does your child have any allergies? If YES, please list. ** If your child requires epinephrine or medication, an Allergy Action Plan must be submitted with a photo of your child attached.*
Has your child recently had a serious illness? If yes, please explain.*
Has your child been hospitalized in the last 12 months? If yes, please explain.*
Does your child have any physical or cognitive limitations? If yes, please describe.*
Does your child currently receive any specialized therapy services (including speech, OT, PT, etc.)? If yes, please list. *
Do you have any concerns regarding your child's health or development? If yes, please share more information about your concerns. *
Immunization Record

Cancelof
Medical Release

Cancelof
Do you have another child enrolled at SSPDS?*

YESNO

Medical Information & Health Record

Please complete one form PER CHILD. If you have another child enrolled at SSPDS, you will be prompted to complete an additional record.
Child's Name
Does your child have any allergies? If YES, will your child bring or keep an EpiPen at the Day School? ** If your child requires epinephrine or medication, an Allergy Action Plan must be submitted with a photo of your child attached.
Has your child recently had a serious illness? If yes, please explain.
Has your child been hospitalized in the last 12 months? If yes, please explain.
Does your child have any physical or cognitive limitations? If yes, please describe.
Does your child currently receive any specialized therapy services (including speech, OT, PT, etc.)? If yes, please list.
Do you have any concerns regarding your child's health or development? If yes, please share more information about your concerns.
Immunization Record

Cancelof
Medical Release

Cancelof

Emergency Medical Care Authorization

St. Stephen Presbyterian Day School is authorized to obtain emergency transportation to and/or emergency medical care for this child at the nearest hospital emergency room, or at the emergency room the EMS/Ambulance Service is required to transport patients to at the time of emergency.
Physician's Name
Physician's Phone Number
Please enter a valid phone number.
Parent Handbook Acknowledgement & Financial Agreement
I acknowledge that I have received a printed and/or digital copy of the St. Stephen Presbyterian Day School Parent Handbook and have been given the opportunity to read the manual and ask questions about it. I understand that a printed copy is always available upon request. I understand the policies contained therein and agree to abide by the policies set forth in the manual.

I understand that tuition for St. Stephen Presbyterian Day School is not subject to adjustments due to illness, absences, or scheduled holidays. Tuition must be paid in advance on a monthly, semester, or annual basis. If a student must withdraw from the program, at least 30 days written notice must be given to the director or one month's tuition will be due.

St. Stephen Presbyterian Day School reserves the right to alter, amend, or otherwise modify these guidelines, in its sole discretion, without prior notice.
Electronic Signature

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it
Signature

Clear
Should be Empty:

SSPDS Registration Form 2025-2026

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

Personal Information & Photography Release

Medical Information & Health Record

Medical Information & Health Record

Emergency Medical Care Authorization

Parent Handbook Acknowledgement & Financial Agreement