2023-2024 Registration Form and Parent Agreement

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Thank you for your response. ✨

Thank you for your submission. Please contact nsplayschoolenrollment@gmail.com if you do not receive a confirmation email after 72 hours.
Select Class Preference (both AM)(required)

CHILD INFORMATION

(required)

Child Resides with:

Yes, child is fully potty trained. **Students must be fully potty trained to attend the program.
Pull-ups and/or diapers are not permitted for licensing requirements.**(required)

MOTHER INFORMATION

FATHER INFORMATION

LEGAL GUARDIAN INFORMATION (only if applicable)

EMERGENCY CONTACT #1

IN CASE OF EMERGENCY – Emergency contacts will be contacted if both parents cannot be reached. It is important to ensure these contacts are reliable sources when the student’s parents may not be available.

EMERGENCY CONTACT #2

IN CASE OF EMERGENCY – Emergency contacts will be contacted if both parents cannot be reached. It is important to ensure these contacts are reliable sources when the student’s parents may not be available.

ALTERNATE PERSON(s) that may pick up your child from playschool

Other persons authorized to pick child up from playschool. If the person is not known to the teacher, personal ID will be required before the student is released. It is important to notify the playschool teacher if anybody other than a parent will be picking up your child.

CHILDS MEDICAL INFORMATION

Does your child have any health problems?(required)
Are there any foods your child cannot eat?(required)
Any vision, hearing, or speech problems?(required)
Are there any medications given regularly?(required)
Fear or additional needs?(required)

AUTHORIZATIONS

I understand the philosophy and function of the playschool and as a member agree to pay the fees as outlined in the handbook, provide a responsible adult for roster duties, participate in parent meetings, and participate in fundraising, field trips and cleaning to maintain my co-operative preschool membership in good standing.(required)

I understand that I am obligated to fulfill my roster duties or find an alternate and repeated failure to attend on a roster day could result in the withdrawal of my child.(required)

I hereby authorize the Treasurer of New Sarepta Playschool to cash checks in relation to playschool fees and any deposit fee should I fail to perform the related duty as outlined in the Parent Handbook.(required)

In the event of an emergency, I hereby authorize that the teacher or attending parent(s) may give my child emergency first-aid treatment. I understand that the teacher will attempt to contact a parent using the emergency information I have provided in the case of an accident or illness. However, I agree that the teacher may request emergency medical care through 911 for my child at any time she deems it necessary.(required)

I give permission for New Sarepta Playschool to post inside the classroom and provide to the playschool members the full names of the children I have enrolled, the full names of myself and other potential adult roster participants in the home and our phone number.(required)

I give permission for my child to leave the premises of New Sarepta Playschool for the purpose of community walks, in town fieldtrips and walking to the community playground(required)

I give permission for my child to be photographed in scheduled playschool activities. Such photographs may be used by the cooperative for publicity or educational purposes. At no time will photos be used with identifying information beyond first name and age/class level in a public forum.(required)

I have read and agree to adhere to the New Sarepta Playschool Handbook and Policies 2023-2024(required)

Interested in being part of the Executive?(required)

I hereby certify that all information on this form is correct to the best of my knowledge and that I have read all of the information in the registration package and agree to abide by the rules set forth by the playschool.(required)

Registration Fee