Little Pilgrims Preschool Registration Form

Class Days

Preschool Tuesday/Thursday Morning Pre-K Monday/Wednesday/Friday Afternoon Pre-K Monday/Tuesday/Thursday Extended Pre-K Monday-Friday

Child's Name

Child's Gender

Male Female

Birthdate

Home address

Phone

Parent or Guardian's name

Occupation

Cell Phone

Email address

This address will receive a confirmation email

Home address (if different)

Parent or Guardian's name

Occupation

Cell phone

Home address (if different)

Name and ages of other children in the family

Has your child been to preschool before? Yes

Where?

Your child needs to be fully potty trained for preschool. It is okay if your child may need some assistance, as we realize they are still learning. Is your child fully potty trained? Yes

Health history of your child (include allergies and medical restrictions)

Are there any emotional or character traits in your child you would like us to know about?

We have a preschool private photo app that we put pictures on of our daily activities. You must be invited in order to be added. Would you like an invite sent to your emails? Yes

How did you hear about Little Pilgrims Preschool?

Were you referred to us by a current/past Little Pilgrims Preschool Family? If, yes, then who?

Authorization Form

Emergency Treatment

Physician

Phone

Insurance

I understand every effort will be made to contact the parent/guardian if any medical or surgical treatment is needed. However, if it is not possible to do so, I hereby give my permission to an emergency phyiscian to secure proper treatment, which may include hospitalization, injections, anesthesia, x-rays or surgery for my child.

Parent/Guardian signature

Date

Picking up from Preschool

List any or all persons authorized to pick up your child from preschool, besides the parents/guardians listed. Children will only be released to those listed below. Identification may be required.

Name/Relationship

Phone

Name/Relationship

Phone

Name/Relationship

Phone

Video/Photo Authorization

Please check one that applies and sign below: I authorize LPP to take videos and photos of my child and allow them to be used in media by LPP, as they see fit. I authorize LPP to take videos and photos of my child but only allow videos/photos of the back of my child's head to be used in media by LPP, as they see fit. I do not authorize LPP to use any videos or photos that are taken of my child to be used on any media platforms.

Signed

Date

Payment $155.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Little Pilgrims Preschool Registration Form

Description

Please Fix the Following