Preschool Registration Form

Preschool Registration Form

Share your child’s details to complete the preschool enrollment request.
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender

Other
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Full Name

First NameLast Name
Relationship to Child
Relationship to Child
Parent/Guardian Employer
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name (Please list someone local)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies or Medical Conditions
Does your child currently have an IEP?
Has your child ever been evaluated for ADD/ADHD, Behavior differences, Autism, or Depression?
My child has hearing, speech, or visual differences
Additional Notes
Beargrass Outdoor Learning does not discriminate based on race, religion, gender, culture, or ability. The more information you can help provide us about your student, the better equipped we are to help them grow.
Religious provisions we should be aware of (foods not eaten, Holidays not celebrated).
Cultural practices we should be aware of
Does your child have any previous peer group interactions or experiences? Daycare, church group, preschool, classes. If yes, what was their comfort level?
Tell us any specific strengths and interests, or dislikes/fears your child may have. (Ex: Natural leader, brave, takes longer to warm up to new people..)
What goals/hopes do you have for your child as they attend Beargrass?
What is your preferred Cohort?
There is a nonrefundable $150 deposit to register that will be used as a supply fee. This can be paid through Square.
I commit to registering my child for the 2026/2027 school year and recognize that my $150 security deposit is non refundable.
We occasionally take photos of the students playing, we hope to use these to keep parents up to date on what is happening throughout the day on our app. With permission, we may use these on social media accounts.
Please click YES if you will give permission to have photos of your child taken.
What is your preferred method of payment? Credit card (3.5% charge) or ACH (1% charge)
If your billing address is different from the one above, please list it here
I (the natural parent or legal guardian) hereby give permission that my child, First Name* Last Name* , may be given emergency medical treatment to include First Aid and CPR by a qualified child care provider at Beargrass Outdoor Learning. I further authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed physician, dentist, health care provider, or hospital when deemed necessary or advisable by the physician to safeguard my child’s health. I waive my right of informed consent to such treatment. Signature*
I give permission for my child to be transported by ambulance or car to emergency center for treatment in the case of emergency. Signature*
I give my permission for my child to be transported off-site should the center need to be evacuated in the event of an emergency. Signature*
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature*

If you choose not to give permission, please provide a court signed waiver and alternate emergency plan in case you cannot be reached.
BOTH PARENTS MUST SIGN OR PARENT/GUARDIAN WITH SOLE CUSTODY OF THE CHILD:
BOTH PARENTS MUST SIGN OR PARENT/GUARDIAN WITH SOLE CUSTODY OF THE CHILD:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about Beargrass?
Should be Empty:

Preschool Registration Form

Beargrass Outdoor Learning does not discriminate based on race, religion, gender, culture, or ability. The more information you can help provide us about your student, the better equipped we are to help them grow.

There is a nonrefundable $150 deposit to register that will be used as a supply fee. This can be paid through Square.