First School of Elon For Office Use Only:
1630 Westbrook Ave. ___Application
Elon, NC 27244 ___Application Fee
336-584-4747 ___Supply Fee
___Current Health Form
___Scholarship Application
Thank you for applying to First School!
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Please fill out one application for each child you are registering.
Class Desired:
____Toddler (Tuesday/Thursday) ____Toddler (Monday/Wednesday/Friday)
____Two-year old (Monday/Wednesday/Friday) ____Two-year old (Monday through Friday)
____Three-year old (Monday/Tuesday/Thursday) ____Three-year old (Monday through Friday)
____Pre-K (Monday through Friday)
Full name of child______To be called______
LastFirstMiddle
Mailing address______
(Include city and zip code)
Sex: Male ____ Female____Birthday: ______
Month Day Year
About Your Family:
Father/Guardian’s Name:______Home Phone:______
Employed at______Occupation:______
Business phone: ______Email:______
Mother/Guardian’s Name:______Home Phone:______
Employed at______Occupation:______
Business phone: ______Email:______
Insurance Carrier: ______Policy Number:______
Are you a member of First United Methodist Church of Elon? ______
Name & Ages of Siblings
Name______Sex _____Age_____
Name______Sex _____Age_____
Name______Sex ____ Age_____
Name______Sex _____Age_____
About Your Child:
Please give any helpful information about your child’s experiences in group settings, such as play groups, Sunday School, Babies Morning Out, etc.
______.
Child’s special talents and interests
______.
Does your child have any special needs, deep fears, or problems that we should know about?
______.
Is your child right or left-handed? ______Is your child toilet trained? ______
Does your child have any physical ailment or known allergies of which we should be aware? ______.
Is there any other information you can provide that would be beneficial for us to know in caring for your child?
______.
Emergency Information:
Child’s physician______Phone______
Family or child’s dentist______Phone______
Local Hospital preference______Phone______
In case of sickness or accident and neither mother nor father (or guardian) can be contacted, call:
(1)Name:______Relationship:______
Cell Phone:______Home Phone:______
(2)Name:______Relationship:______
Cell Phone:______Home Phone:______
If you cannot pick up your child, please give the names, contact information and relationships of persons to whom the child can be released:
(1)Name:______Relationship:______
Cell Phone:______Home Phone:______
(2)Name:______Relationship:______
Cell Phone:______Home Phone:______
(3)Name:______Relationship:______
Cell Phone:______Home Phone:______
(4)Name:______Relationship:______
Cell Phone:______Home Phone:______
I agree that the Director may authorize the physician of her choice to provide emergency care in the event that neither I nor the physician listed above can be reached and to transport your child to the nearest hospital if deemed necessary.
Parent/Guardian’s Signature______Date______
First School of Elon (a mission of First United Methodist Church of Elon) admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to the students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship program, and other school-administered programs.
First School of Elon
Field Trip Permission
______has my permission to go on all field trips that will be taken during the school year. Information concerning any trip that will leave the Church property will be issued in advance.
Parent/Guardian’s Signature:______Date:______
First School of Elon
Class Distribution List
Teachers like to share information with parents for parties and other school/class related activities. Please signbelow if you give your child’s teacher permission to do this.
Parent signature:______
First School of Elon
Consent for Antiseptic or Allergic Reaction Medication
I give First School of Elon staff my permission to apply over-the-counter types of antiseptic mediation (such as Neosporin, peroxide, A&D Ointment, Bactine, etc) to ______if he/she has a cut or a scrape that warrants such medication.
This permission form is applicable at any time my child is in attendance at First School of Elon.
Child’s Name:______
Parent/Guardian’s Signature:______Date______
FirstSchool of Elon
Consent to Publish Pictures
From time to time, pictures and articles about First School may appear in the Church newsletter, in publicity about our program, in our church newsletter, on our website, on the church website, and/or our FaceBookPage.
We would appreciate your signature to give First School permission to use your child’s picture and name.
Child’s Name:______
Parent/Guardian’s Signature:______Date:______