ENROLLMENT AND TUITION POLICY AGREEMENT

Date of Registration
Date of Registration
Start Date
Start Date
Child's Information
Child's Name *
Child's Name
Child's Address *
Child's Address
Child's Date of Birth *
Child's Date of Birth
Parent/Guardian Information
Mother's Name
Mother's Name
Mother's Address
Mother's Address
Mother's Phone/Cell
Mother's Phone/Cell
Mother's Employer's Address
Mother's Employer's Address
Mother's Employer's Phone
Mother's Employer's Phone
Father's Name
Father's Name
Father's Address
Father's Address
Father's Phone/Cell
Father's Phone/Cell
Father's Employer's Address
Father's Employer's Address
Father's Employer's Phone
Father's Employer's Phone
Medical Contact Information
Doctor's Address
Doctor's Address
Doctor's Phone
Doctor's Phone
Dentists Address
Dentists Address
Dentists Phone
Dentists Phone
Hospital Address
Hospital Address
Hospital Phone
Hospital Phone
Authorized child pick up and/or illness contacts
Child will be released only to the custodial parents or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident, or emergency. If for some reason the custodial parent or legal guardian cannot be reached.
Authorized Person's Address
Authorized Person's Address
Authorized Person's Work Phone
Authorized Person's Work Phone
Authorized Person's Home Phone/Cell
Authorized Person's Home Phone/Cell
Second Authorized Person's Address
Second Authorized Person's Address
Second Authorized Person's Work Phone
Second Authorized Person's Work Phone
Second Authorized Person's Home Phone/Cell
Second Authorized Person's Home Phone/Cell
Third Authorized Person's Address
Third Authorized Person's Address
Third Authorized Person's Work Phone
Third Authorized Person's Work Phone
Third Authorized Person's Home Phone/Cell
Third Authorized Person's Home Phone/Cell
child's allergies
Please list allergies, special medical or dietary needs or other areas of concern: