Carus Preschool Registration Form

Carus Preschool Registration Form For The 2023/2024 School Year

Carus Preschool admits students of any race, color, and national or ethnic origin.
REGISTRATION FEES
Payment of a non-reundable registration fee is required.

Single Student: $80.00

Two or More Students: $70.00 each

Registration fee payments are accepted via Zelle or Check
- Online payment can be completed using Zelle to teacher.cassidy@outlook.com
- Payment by check must be payable to Carus Preschool and must be sent to P.O. Box 974, Beavercreek OR, 97405
Zelle (Preferred)Check
CLASS INFORMATION
Traditional Slot (no parent help days required - limited space available)
T/TH am Class (3-4yr)(Waitlisted) M/W/F am Class (4-5y)
STUDENT INFORMATION
Name*

First NameLast Name
Preferred First Name
To be used in class if different from above.
Gender
Birth Date *

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list any of the following: Dietary Restrictions, Food allergies, Current medications, Medication allergies, or Chronic health concerns.*
YesNo
YesNo
If yes, what county?

EMERGENCY CONTACT 1

Name of person student can leave with if guardian is not picking up child or in case of emergency and guardians cannot be contacted.
Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
EMERGENCY CONTACT 2

Name of person student can leave with if guardian is not picking up child or in case of emergency and guardians cannot be contacted
Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
FAMILY DOCTOR
Name or Practice*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please inform us of any vital information you think we may need to know in the event of an emergency.
STATEMENT:

In case guardians cannot be reached, my signature is authorization for our Physician named above, the Physician of the school’s choice, the Beavercreek Fire Department, or the Emergency room of Willamette Falls Hospital to provide whatever emergency care is necessary in the event of injury or accident.
Signature of Parent or Guardian*
Should be Empty:

Carus Preschool Registration Form For The 2023/2024 School Year