| The Starting Line Preschool 2010-2011 Enrollment Application & Agreement Student Information: Student Name ________________________________________________ Age ____________ Birthday _____________________ _____ 2’s(T&Th) _____3’s (M,W,F) _____4’s (M,T,W,Th) ______Pre-K (M,T,W,Th) _____Enrichment (T&Th) _____Enrichment (M,W) ______Enrichment (M,T,W,Th) Student’s brother(s) and sister(s): Name ________________________ Age ____________ Name ________________________ Age ____________ Name ________________________ Age ____________ Name ________________________ Age ____________ Parent Information: Mother’s Name _________________________________________ Father’s Name _____________________________________ Home Address ___________________________________________________________________________________________ City __________________________________________________ Zip _____________________________ Home Phone _________________________________________ Cell Phone __________________________________________ Father’s Employment ___________________________________________________ Wk Phone ___________________________ Mother’s Employment ___________________________________________________ Wk Phone __________________________ Email Address: ___________________________________________________________________________________________ ANY MEDICAL CONDITIONS WE SHOULD KNOW ABOUT. (FOOD ALLERGIES, ETC.): ________________________________________________________________________________________________________ IN CASE OF AN EMERGENCY, OTHER THAN PARENTS WHOM MAY WE CONTACT? Name _________________________________________________________________ Phone ___________________________ RELEASE: All precautions will be taken to prevent accidents while your child is in class. Simple first aid will be administered to all minor injuries; parents or doctors will be notified when necessary. I hereby consent to have my child participate in programs offered by the Starting Line Preschool and their employee’s. It is hereby agreed that I, my child, my heirs and executors, waive and release all rights and claims for damages that I may have at any time against the Starting Line Preschool, their employee’s, and its representatives, whether paid or volunteer, for any injury or damages in connection with the Starting Line program. The risks involved in respect to such a program are fully understood. SIGNATURE (Parent or Guardian) ___________________________________________________ Date ______________________ |
Registration Form
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| Print page and send in with Registration Fee to: Starting Line Preschool Attn: Diane Atkins 575 W. Carmel Drive Carmel, IN 46032 |
| Non-refundable $45.00 Registration Fee is due to reserve place in class. No Refunds. No Make-ups. A $25 late fee for payments received after the 10th of the month. $40 Charge for returned checks. A $150 withdrawal fee per class per student will be applied to students withdrawing from class during the year. We follow the Carmel Clay School System for vacation and holidays. |