Enrollment Contract — Some Place Awesome in Tremonton

Online Enrollment Contract — Some Place Awesome in Tremonton

Some Place Awesome — 83 S Tremont St, Tremonton, UT 84337. Enrollment and contract in one. One per child.
Your child
Child's full name

First NameLast Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Requested start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child lives with
Preferred name
Ethnicity
Race
Parents
Parent or Guardian 1 Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is there a second parent or guardian?
- Emergency and health
- Where we meet in an emergency
- Emergency contact name
- Emergency contact phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Pick-up password
- Authorized pick-up person 1 name
- Authorized pick-up person 1 phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Authorized pick-up person 2 name
- Authorized pick-up person 2 phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Any allergies?
- List all allergies — food, medication, other
- Any medical conditions?
- Describe the conditions
- Regular medications and anything else we should know
- Physician name
- Physician phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Schedule, rate and payment
- Days you need care
- Typical drop-off time
  
  Hour Minutes
  
  AM/PM Option
- Typical pick-up time
  
  Hour Minutes
  
  AM/PM Option
- Weekly rates
- Which rate applies?
- Is your child 4 or older and not fully potty trained?
- How would you like to pay?
- Send the secure payment link by
- Payment note
- The agreement
- TUITION AND PAYMENT
- LATE FEES AND BALANCES
- ILLNESS AND HEALTH
- INDIVIDUALIZED HIGH RATE CARE
- EMERGENCY MEDICAL AND MEDICATION
- SCHEDULE AND ADDITIONAL CARE
- HOLIDAYS AND CLOSURES
- SUPPLIES AND DAILY CARE
- TRANSPORTATION AND SCHOOL
- I have read and agree to the Tuition and Payment terms, and I authorize my saved payment method to be charged for late or outstanding amounts.
- I have read and agree to the Late Fees and Balances terms, including collection costs and attorney's fees.
- I have read and agree to the Illness and Health policy.
- I have read and agree to the Individualized High Rate Care terms.
- I authorize emergency medical care and medication as described, and accept responsibility for resulting costs.
- I have read and agree to the Schedule and Additional Care terms.
- I have read and agree to the Holidays and Closures terms and the Supplies and Daily Care terms.
- I give permission to transport my child for field trips and to and from school, and I understand the school transportation rules.
- Do you give permission for your child's name and image to be used?
- Draw your signature
- Type your full legal name
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- ESIGN/UETA Consent
- First-Day Supplies
Should be Empty:

Online Enrollment Contract — Some Place Awesome in Tremonton

Your child

Parents

Emergency and health

Schedule, rate and payment

The agreement