Registration Form 2026-2027

2026-2027
Please indicate class choice:
Please register your child for the appropriate class based on your child's age as of August 31.
2-day ($280/mo.)3-day ($325)5-day ($390)
3-day ($325/mo.)5-day ($390)
M-F ($390/mo.)
M-F ($425/mo.)
Child's Name*

First NameLast Name
Prefers to be called:
MaleFemale
Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other school(s) attended
How did you hear about Peas in a Pod?
Parent Information:
Parent 1*

First NameLast Name
Address (if different from child)
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Employer
Parent 2

First NameLast Name
Address (if different)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Employer
Siblings and Ages
Emergency Contact/ Authorized Pick-up

In an emergency, if neither parent can be reached, we will call contacts as listed below. These people also have permission to pick your child up unless otherwise noted.
Name

First NameLast Name
Phone
Format: (000) 000-0000.
Relationship
Name

First NameLast Name
Phone
Format: (000) 000-0000.
Relationship
Important Information to share with your teachers:
Special Medical Information (i.e., food allergies, chronic conditions)
Any pronounced difficulties or concerns? Examples - separation anxiety, medical problems (including physical disabilities), difficulties getting along with peers, etc.:
YesNo
Please include anything else that you would like to share about your child, or expectations that you may have:
**I understand that a registration fee of $100 ($80 for each additional sibling) and the first month's tuition must accompany this registration form, and that these are non-refundable.
Parent's Signature*
Date

MonthDayYear
Date
**A copy of your child's immunization records from your doctor should be submitted before school begins. Your doctor's office may email the information to debbie@peaspreschool.com.
MEDICAL CONSENT AND LIABILITY RELEASE 2026-2027
We, the parents of Child's Name do hereby relieve Peas in a Pod and all employees from any liability or fault due to any accident or illness that may occur to him/her while he/she is in attendance of the school. Be it further agreed that said parents give any and all employees in charge on that day that your child is in attendance, permission to grant to any and all medical personnel the right to treat your child for any accident or illness in the event that said parent(s) cannot be reached before treatment is considered necessary. The decision that treatment is necessary will be based on the opinion of a licensed physician. Said parents do hereby relieve any and all employees of Peas in a Pod of any liability in connection with the medical treatment to your child.
Parent Signature:*
Date:

MonthDayYear
Date
PHOTO RELEASE FORM 2026 - 2027
Occasionally photographs of our program and children will be taken for educational and publicity (Facebook page or website) purposes. These photographs will be representative of the enriching experiences offered to your child during the school year so we can share our school with other families interested in joining us. Please check your choice:
I DoI Do Not
Give permission for my child to be photographed for use in school/church publications/presentations, as well as for use on online classroom and school community newsletters (accessed only by school community), the website for Peas in a Pod, as well as Peas Instagram/Facebook. This permission is applicable for current as well as future projects for this school year (2026-2027).
Parent Signature:*
Date

MonthDayYear
Date
Should be Empty:

Parent Information:

Important Information to share with your teachers:

MEDICAL CONSENT AND LIABILITY RELEASE 2026-2027

PHOTO RELEASE FORM 2026 - 2027