PRESCHOOL REGISTRATION
January 30th- March 31st(Ages 3-5, potty trained)
8:15 a.m. - 11:15a.m. (Monday, Tuesday, Thursday, and Friday)
Child’s Name ______Age (as of 1/31/17) ____
Preferred Name ______Sex _____
Date of Birth ___ Home Phone ______
Father’s Name ______Cell/work # ______
(Guardian)
Mother’s Name ______Cell/work # ______
(Guardian)
Home Address______
Street Address
______
City, State, Zip
Email Address (es)______
Names and ages of other children in family/household______
______
List two persons (other than parents) who could be reached in case of emergency:
Name ______Phone ______
Name ______Phone ______
***Does your child have any allergies, serious illnesses, or handicaps?***
______
If yes, please explain. ______
Who will be bringing your child to preschool? ______
(Continued on back)
Please bring your PHOTO ID when picking up your child.(Continued on reverse)
List other persons who may pick up your child.
Name Phone Number(s)______
We use photographs for memory books and media coverage and student portfolios. Do you grant permission to have your child photographed?
Yes_____No_____ X (signature)______
In the event of disruptive behavior of your child, you will be notified.
If disruptive behavior continues, it may result in dismissal from the preschool program.
We will provide your child with a safe environment. However, in the event of an accident or injury, Locust Grove High School and the Henry County Board of Education cannot be held liable.
Please sign the consent form below if you agree with the following statement. If my child is injured, I authorize Locust Grove High School personnel to seek emergency treatment.
Parent’s Signature ______Date ______
Child’s Physician ______Phone ______
- Tuition is free with a one-time registration fee of $256 made payable to LGHS.
- Pre-pay 8 weeks ($216– saving $40)
- Applications are accepted on a “first come first serve” basis.
- Registration fee must be paid for your child to be placed on the roll.
You will receive a text/email regarding open house and the first day of preschool.
We are asking that each preschool student bring:
- a container of Clorox wipes, or other wipes
- a bottle of hand sanitizer
- a box of snack or sandwich size zip lock style bags
- a box or two of tissues
January 24th, 2017 is our registration deadline.
Send completed form, a copy of immunization record and check(must contain a phone number) to:
ATTN: Brandee Tabacchi
Email:
Locust Grove High School
3275 South Ola Road
Locust Grove, GA 30248
Phone: 770-898-1452 FAX: 770-898-7076