Grace Point Early Academy Enrollment Form
For ages 18 months - 3 years old. Hours: 8:00AM - 12:00PM See below for pricing details.
Tuition & Enrollment Pricing
Child's Information
Child's Name
*
First Name
Middle Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
Gender:
*
Female
Male
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preschool Enrollment Schedule
Expected Start Date
-
Month
-
Day
Year
Date
Please Check Desired Schedule:
*
2-Day: Tuesday & Thursday
3-Day: Monday, Wednesday & Friday
4-Day: Monday - Thursday
5-Day: Monday - Friday
Additional Information Regarding Attendance:
If you would prefer a different schedule, please type that here so we can see if it will work for us.
Parent/Guardian & Emergency Contact Information
Primary Guardian Name
*
First Name
Last Name
Email:
*
example@example.com
Relationship:
*
Mother, Father, etc
Mobile Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Guardian Name
First Name
Last Name
Email:
example@example.com
Relationship:
Mother, Father, etc.
Mobile Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Same with the child
Different Address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact 1
*
First Name
Last Name
Relationship
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact 2
First Name
Last Name
Relationship
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Do you want to add any notes to this section?
Marital status of parents, medical information, people who the child cannot be released, etc
Medical & Allergy Information
Doctor's Name:
Doctor's Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Known Allergies or Medical Conditions:
Please explain any conditions of the child for better understanding.
Authorized Pickup Persons (Other than ones listed above.)
Name:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship:
Name:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship:
Photo/Video Consent
I give permission for my child to be photographed, or video recorded during preschool activities. These images/recordings may be published on our website, Facebook group, or other promotional areas.
*
Yes, I give consent.
No, I do not give consent.
Preschool Policies
Signature
Date:
Parent/Guardian Signature
*
Submit
Should be Empty: