Noah's Ark Preschool Registration Form

Noah’s Ark

Preschool

302 N.E. 2nd Street

Buffalo, MN 55313

Phone number: 763-682-1368

Noah's Ark Preschool Registration Form

Child's name______Birthdate____/____/______

Home Address______

Parents name______Birthdate____/____/______Home phone number ______Cell phone number ______Work number______

Names & birth dates of siblings:

______Birthdate____/____/______

Church affiliation: ______

How did you find out about Noah's Ark Preschool? ______

Does anyone in your family have any hobbies or skills they would be willing to share with the children in preschool? yes / no

If yes, please share an example: ______

Who, besides parents listed, is authorized to pick up your child from preschool?

Name______Relationship ______Phone number: ______

Please Mark the class you wish your child to attend…

______3&4 year olds class- Tuesday & Thursday 9:00am-11:30am $115.00 per month

______4 & 5 year old class – Monday, Wednesday Friday 9:00am-11:30am $ 130.00/ month

______4 & 5 year old EXTENDED DAY – Monday, Wednesday & Friday 9:00am-2:00pm $180.00/month

$50.00 Registration Fee due with registration

Noah’s Ark reserves the right to cancel classes based upon enrollment. In event of cancellation, registration fees will be returned to families.

Personal Information About Your Child

1. What do you enjoy most about your preschooler? ______

2. What kind of activities does your child especially like? ______

3. Are there any activities that he/she typically avoids? ______

4. Does he/she have any strong fears? ______

5.What would you say are your child’s greatest strengths?

______

6. In what areas would you like to see your child grow?

______

7. Who lives in your child’s home? ______

8. Why have you chosen to enroll your child in preschool?

______

Emergency Information

Child's name: ______Birthdate: ____/____/______

Address:______

Parent/Guardian Name(s): Home/Cell Number Work Number 1.______

2.______

Emergency Contacts Name (s): Relation Phone Number

______
______

Physician: ______

Clinic name/phone number:______

Hospital: ______

Last DPT: ______Allergies: ______Medications:______

Dentist: ______

Dental Clinic name/phone number: ______

Other significant health information: ______

I give permission to Noah's Ark Preschool to make whatever emergency measures as judged necessary for the care and protection of my child while under their supervision.

In case of medical emergency, I understand that my child will be transported to an appropriate facility by the local emergency unit for treatment if the local emergency resource deems it necessary.

It is understood that in some medical situation, the staff will need to contact that local emergency resource before the parent, child's physician and/or other adult acting on the parent's behalf.

Signature______Date______/______/______

PERMISSION AGREEMENT

Please place your initials next to each item to give permission.

A. I hereby grant permission for my child to use all of the play equipment and participate in all of the activities of the school. ______

B. I hereby grant permission for my child to leave the school premises under the supervision of a staff member for neighborhood walks or for fieldtrips in authorized vehicles. ______

C. I hereby grant permission for the Director or Acting Director to take whatever steps may be necessary to obtain emergency medical care if warranted. These steps may include, but are not limited to, the following: ______

1. Attempt to contact a parent or guardian.

2. Attempt to contact the child’s physician.

3. Attempt to contact the parent through any of the persons listed on the emergency record completed for Noah’s Ark Preschool

4. If we cannot contact the parent or the child’s physicians, we will do any or all of the following: (a) call another physician; (b) call an ambulance; (c) administer syrup of ipecac (which induces vomiting) as instructed by Poison Control; (d) have the child taken to an emergency hospital in the company of a staff member.

5. Any expenses incurred under #4 above will be borne by this child’s family.

D. The school will not be responsible for anything that may happen as a result of false information given at the time of enrollment. ______

F. The school will not assume responsibility for a child who has not been signed in when he/she arrives for the day. ______

G. Public relations –I give permission for my child’s photo to be taken and/or video recorded. Photos and recordings will be used within the program (bulletin boards, teaching materials, etc.) or in promotional materials for the preschool (newspaper, website, flyers etc.). Photos used for public relations will generally not identify any child by name. Children’s names and faces will not appear on Facebook. ______

Signature______Date ____/_____/______

(Parent or legal guardian)

PRESCHOOL EDUCATION

TUITION AGREEMENT FORM

(Tuesday & Wednesday - $115.00 per month)

Dear Parent(s)

Please review the regulations below and sign. Your cooperation is essential to the successful operation of the preschool in providing quality education for your child.

1. Tuition payment is due on the first attendance day of each month for that month. An enrollment fee of $50.00 required at registration. Check or money order must be used to pay all tuition for record-keeping purposes. Make checks payable to Noah’s Ark Preschool.

2. Days your child is absent cannot be made up or tuition refunded, as operating expenses continue whether or not the child is in attendance.

3. Tuition rate will be $115.00 per month for 2 days per week from September through May. Your child is scheduled to attend the preschool on Tuesday and Thursday from:

9:00 a.m. – 11:30 a.m.

Noah’s Ark Preschool reserves the right to dismiss a student when payment is delinquent for more than one month.
Noah’s Ark reserves the right to cancel classes based upon enrollment. In event of cancellation, registration fees will be returned to families.

Written notice must be submitted to the director 2 weeks prior to termination from preschool.

I have read the above Tuition Agreement Form and agree to comply with the requirements as listed.

______/______/______Parent Signature Date

PRESCHOOL EDUCATION

TUITION AGREEMENT FORM

(Monday, Wednesday & Friday - $130 per month)

Dear Parent(s)

Please review the regulations below and sign. Your cooperation is essential to the successful operation of the preschool in providing quality education for your child.

2. Days your child is absent cannot be made up or tuition refunded, as operating expenses continue whether or not the child is in attendance.

3. Tuition rate will be $130.00 per month for 3 days per week from September through May. Your child is scheduled to attend the preschool on Monday, Wednesday, and Friday from:

9:00 a.m. – 11:30 a.m.

Noah’s Ark Preschool reserves the right to dismiss a student when payment is delinquent for more than one month.
Noah’s Ark reserves the right to cancel classes based upon enrollment. In event of cancellation, registration fees will be returned to families.

Written notice must be submitted to the director 2 weeks prior to termination from preschool.

I have read the above Tuition Agreement Form and agree to comply with

the requirements as listed.

______/______/______Parent Signature Date

PRESCHOOL EDUCATION

TUITION AGREEMENT FORM

(Monday, Wednesday & Friday Extended DAY - $180 per month)

Dear Parent(s)

Please review the regulations below and sign. Your cooperation is essential to the successful operation of the preschool in providing quality education for your child.

2. Days your child is absent cannot be made up or tuition refunded, as operating expenses continue whether or not the child is in attendance.

3. Tuition rate will be $180.00 per month for 3 days per week from September through May. Your child is scheduled to attend the preschool on Monday, Wednesday, and Friday from:

9:00 a.m. – 2:00 p.m.

Noah’s Ark Preschool reserves the right to dismiss a student when payment is delinquent for more than one month.
Noah’s Ark reserves the right to cancel classes based upon enrollment. In event of cancellation, registration fees will be returned to families.

Written notice must be submitted to the director 2 weeks prior to termination from preschool.

I have read the above Tuition Agreement Form and agree to comply with

the requirements as listed.

______/______/______Parent Signature Date