Smarty Pants Preschool LLC
Enrollment Form
Childs Full Name:Birth Date: Gender:
Address:Home Phone:
City:State:Zip Code:
Nickname:Social Security #:
Mothers Full Name:Home Phone:
Address: Social Security #:
City:State:Zip Code:
Occupation:Work Phone: ext.:
Name of Employer:Pager/Cell #:
Business Address:City:
Work Hours:Drivers License #:
Fathers Full Name:Home Phone:
Address: Social Security #:
City:State:Zip Code:
Occupation:Work Phone: ext.:
Name of Employer:Pager/Cell #:
Business Address:City:
Work Hours:Drivers License #:
Parent/Guardian with legal custody information
Parents are:Married Living TogetherDivorcedSeparated
WidowedSingle
Other Household Members:
NameAge
Relationship
NameAge
Relationship
Emergency Contacts
(within 20 miles of preschool, other than parent or guardian)
Primary Emergency Contact
Home Phone:Work Phone:
Pager/Cell:Relationship to Child:
Address:
Secondary Emergency Contact
Home Phone:Work Phone:
Pager/Cell:Relationship to Child:
Address:
Person(s) authorized to pick up my child (other than those already listed):
Name:
Comment:
Person(s) NOT authorized to pick up my child:
Name:
Comment:
About your Child
What foods does your child especially like?
Especially Dislike?
Favorite toys, games, activities?
Is your child toilet trained?
What words does your child use for the toilet?
How does your child express anger or frustration?
Does your child have any specific fears?
Explain
When your child is upset, what helps to comfort him/her?
How do you discipline your child?
Has your child been taking afternoon naps? If so how long?
If not, why?
Special toys or blanket at nap?
Special family situation? (such as custody specifications, problems arising from situations, etc)
Anticipated adjustment problems?
Any Disorders/developmental (slow, advanced) diagnosed or suspected?
Previous childcares facilities attended?
Any problems at previous childcare facilities?
Expectations?
Other Comments:
By signing this contract you are agreeing to pay the amount for childcare services outlined in the parent handbook. Payment is due in full on the first week of every month.Late fees will be administered as stated in the parent handbook and are required to be paid in full.
Also, by signing this contract, you acknowledge that you have read, understand, and plan to follow all discipline policies as well as any other procedures, changes in policies, and pricing set by Smarty Pants Preschool LLC outlined in the parent handbook.
I (we) agree to resolve any disputes with Smarty Pants Preschool LLC, or their owners, employees and representatives through arbitration. I (we) understand any decision made by an arbitrator is legally binding.
Person(s) signing contract are responsible for payment.
Parent/Guardian (Mother) Date:
Parent/Guardian (Father) Date:
I understand this is a legally binding contract, and I have read it and understand it.
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