LMS 2026-2027 Year Registration Form

Registration Date:

Date

Child 1's English Name:

First NameLast Name

Child 1's Chinese Name:

Child 1's Birth Date:

MonthDayYear

Child 1's Gender:

Child 1's Chinese Learning:

Child 1's School Name:

Child 1's Room Number:

Child 1's Grade:

Child 1's Dismissal Time:

Hour Minutes

AM/PM Option

Child 1's Early Dismissal Date:

Child 1's Early Dismissal Time:

Hour Minutes

AM/PM Option

Child 1 Usually Take A Nap:

Child 1 Need to Pick Up:

Child 2's English Name:

First NameLast Name

Child 2's Chinese Name:

Child 2's Birth Date:

MonthDayYear

Child 2's Gender:

Child 2's Chinese Learning:

Child 2's School Name:

Child 2's Room Number:

Child 2's Grade:

Child 2's Dismissal Time:

Hour Minutes

AM/PM Option

Child 2's Early Dismissal Date:

Child 2's Early Dismissal Time:

Hour Minutes

AM/PM Option

Child 2 Usually Take A Nap:

Child 2 Need to Pick Up:

Father's Name:

First NameLast Name

Father's Mobile Number:

Format: (000) 000-0000.

Father's Work Number:

Format: (000) 000-0000.

Father's E-mail:

example@example.com

Mother's Name:

First NameLast Name

Mother's Mobile Number:

Format: (000) 000-0000.

Mother's Work Number:

Format: (000) 000-0000.

Mother's E-mail:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name:

First NameLast Name

Relationship:

Emergency Contact Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Physician's Name:

Physician's Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Please select if your child has any allergies or health condition concerns below.

If your child has any of it, please specify.

Medications:

Other Dietary / Activity Restrictions:

Special Routines:

Little Mustard Seed Attending Schedule for Child 1: (Part-time students must enroll for at least 3 days.)

Little Mustard Seed Attending Schedule for Child 2: (Part-time students must enroll for at least 3 days.)

＊10% sibling discount for the second child (Valid only for a five-day session): Please contact LMS for more information.

I agree that any controversy of claim arising out of or in any way related to this contract or to my child’s enrollment, attendance at Little Mustard Seed Campus, Inc. (LMS), will be determined by submission to arbitration to be held in San Jose, CA in accordance with California Code of Civil Procedure, and not by lawsuit or by resort to court process (except as applicable law provides for judicial review of arbitration proceedings). This agreement includes arbitration of claims against LMS of any of its staff that there has been any wrongful act or omission by LMS or a member of its staff, intentional or otherwise, the decision of the arbitrators may be entered in any court having jurisdiction of such matters. By signing this, I am agreeing to have any issue or claim arising out of attendance at LMS decided by neutral arbitration and I am giving up my right to jury or court trial.

I HAVE READ THE ABOVE CAREFULLY AND HAVE FULLY UNDERSTOOD THE CONTENT AND CONSEQUENCES OF THESE AGREEMENTS BEFORE SIGNING.

Signature of participant; If under 18, by Parent/Legal Guardian

LMS 2026-2027 Year Registration Form

Child 1 Information

Child 2 Information

Parent/Guardian Information * Required *

Medical Information

Any Allergies or Health Condition Concerns **

Permission to use child's photographs **

Please click Review Answers to submit the registration form.