Enrollment Form

* = Required Information

Child's Information

Child's Full Name *

Birth Date *

Date Child will start *

Schedule Of Attendance (check all that apply)

Preferred Payment Plan

Payment Plan

Monthly

Bi-Weekly

Person Responsible For Child

Parent/Guardian

Address

Home Phone

Cell Phone

Work Phone

Email Address

Allergies/Special Needs

Allergies

Special Needs

Fears

Emergency Information

Name

Address

Relationship

Name

Address

Relationship

Name

Address

Relationship

Present Type Of Child Care

Type Of Child Care

Babysitter

Home Care

Relative

Previously Attended Preschool(s)

Attended Preschool(s)

How did you hear about Hazel’s Christian Preschool & Child Care Center?
Phone Directory
Drive By
Referred By
Other

Who may we thank for referring you?

Please explain

Parent’s Pledge

I agree to have my child’s immunization record current and kept up to date. My child will have a visual health check upon arrival to preschool.

I agree to abide by the Center Director’s decisions in the event that my child may be excluded from the preschool on any day due to sickness or disease that may affect other children.

I understand that the preschool has permission to take appropriate measures for emergency treatment for my child if I cannot be reached. In the event of a serious or contagious disease that my child has contracted and missed preschool, a physician’s note may be required for my child to return to preschool.

The school has full authority to discipline my child if he/she does not comply with the standards of the school; I willingly agree to withdraw my child after discussion with the Center Director if that is the concluded decision.

I agree to support the preschool in enforcing its policies and rules.

For the safety of my child, I agree to sign the full name of the child in and out each day on the attendance sheets along with my full name. If someone other than the person(s) listed are picking up my child I will send a written note and call the preschool indicating my permission.

I understand if I don’t sign in/out correctly and a fine by Community Care Licensing is given to Hazel’s Christian Preschool & Child Care Center I will be required to pay the fine given.

I have read the terms stated in this pledge and by my signature below, I affirm my support to all of the school’s policies.

Parent Name

Date

Hazel’s Christian Preschool & Child Care Center has a non-discriminatory racial policy and admits students of any race to all rights, privileges, and activities made available to all students. The administration; however, reserves the right to refuse admission to anyone unwilling to comply with the school’s regulations.

Parent's Name

Date

Parent Agreement

I agree to pay the $200.00 registration fee and additional sibling fees $100.00 (if applicable) at the time of enrollment and annually each May. I understand that this fee is non-refundable. I agree to pay in advance my tuition payments, based on my choice of payment plans. I understand that my child will be terminated for missing tuition payments. I understand that this form must be completed and returned to the Center Director prior to the first day of enrollment.

Acceptance Agreement

By signing below and returning this application to Hazel’s Christian Preschool & Child Care Center the parent/guardian has acknowledged acceptance. A 30 day trial period will be granted to the child to ensure proper placement.

Binding Arbitration

For alleged violation of any duty to parent/guardian arising out of client wishes agreement, irrespective of legal theory, must be decided by binding arbitrating and not by lawsuit or resort to court process, except as applicable law provides for judicial review or arbitration proceedings.

I understand that the parent/guardian that enrolled their child (ren) under this agreement give up their right to court or jury trial to the use of binding arbitration.

Parent's Name

Date