2025-26 Living Hope Preschool Application Form

Living Hope Preschool Parental Emergency Medical Consent 2025-2026

Living Hope Preschool
Child's Doctor*
Doctors Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Hospital*
Preferred Hospital Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Child's Dentist*
Dentist's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Dentist's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child have any special needs that I need to be aware of?
In the event that my child(ren) (listed above) may require medical and/or surgical care while I am out of the city or unable to be reached. I hereby give my consent to Medical and/or surgical treatment to the above hospital and above doctor or his/her designee to provide this care. In the event that my child(ren) (listed above) may require dental and/or dental surgical care to the above dentist or his/her designee to provide this care. I agree to pay all the costs and fees contingent on any emergency medical care and/or treatment for my child(ren) as secured or authorized under this consent.

Please note: Every effort will be made to notify parents/guardians immediately in case of emergency. This form will be presented upon admission for treatment.
I have read and understand the emergency medical procedures to be folled by Living Hope Preschool staff in the event of an emergency.

I hereby authorize Living Hope Preschool to call an ambulance or paramedic in case of accident or acute illness and to arrange for necessary medical, dental or surgical care in case I am not immedately available. I also agree to accept financial responsibility for the cost of the above mentioned servicer.

It is understood that a conscientous effort will be maded first to contact the parents or guardian and then to contact the responsible adults designated as emergency contacts before such action will be taken.

I further hold harmless Living Hope Bible Church or Living Hope Preschool from any liability regarding the care of my child(ren) while he or she is in their care, custody, or control.

This consent will be in effect while the child(ren) is enrolled in this facility.
Signature*
Date*

MonthDayYear
Date

Emergency Contact Information
Emergency Contact #1

First NameLast Name
Relationship to child(ren)*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Emergency Contact #2

First NameLast Name
Person #2 to Contact if Parents/Guardians are unavailable and are authorized to pick up child(ren)*

First NameLast Name
Relationship to child(ren)*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Persons Allowed to Pick Up My Child(ren)
Person #1

First NameLast Name
Relationship to child(ren)*
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Person #2

First NameLast Name
Relationship to child(ren)
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Person #3

First NameLast Name
Relationship to child(ren)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Person #4

First NameLast Name
Relationship to child(ren)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Anyone NOT allowed to pick up my child

First NameLast Name
Date

MonthDayYear
Date

Signature
Living Hope Preschool Permission Slip 2025-2026
Child #1 Name*

First NameLast Name
Child #2 Name

First NameLast Name
Field Trips

Throughout the year, your child(ren) will have the opportunity to attend various field trips. Families will be notified prior to these events. Your permission on this form will allow participation for all field trips.

Examples - Pre-K trips to library, Douds Fire Station, parks, The Depot, Gothic House, Capturing Life Photo Studio, OB Nelson Park, etc.
I give permissionI do not give permission
Pictures

Throughout the year, various pictures of your child(ren) may be taken during class activities, programs, or field trips. Your permission on this form will give permission for Living Hope to display these pictures for promotional purposes on our Living Hope Preschool Facebook page, Living Hope Bible Church Facebook page, other social media and in our monthly newsletter.
I give permissionI do not give permission
Facebook Page(s) & Living Hope Bible Church Website

Living Hope Preschool has a Facebook page and a page on Living Hope Bible Church's website. We would like to post pictures of the children working/playing at school and on our field trips. Please check one box below.
I give permission to post pictures of my child(ren) on Living Hope Preschool's Facebook page, Living Hope Bible Church Facebook page, and Living Hope Bible Church website.I do not give permission to post pictures of my child(ren) on the Living Hope Preschool Facebook page, Living Hope Bible Church Facebook page, and Living Hope Bible Church website.
I have read and checked the boxes of the above statements, either granting permission or requesting an exclusion for my child(ren).*
Date*

MonthDayYear
Date
Should be Empty:

Living Hope Preschool Application

Welcome to Living Hope Preschool

Child Information

Parent/Guardian Information

Living Hope Preschool Parental Emergency Medical Consent 2025-2026

Emergency Contact Information

Persons Allowed to Pick Up My Child(ren)

Living Hope Preschool Permission Slip 2025-2026