CARSTAIRS PLAYSCHOOL 2019-2020 REGISTRATION PACKAGE

Childs Name *
Childs Name
Parent's Name *
Parent's Name
Program *
Please note children must be 3 years old by September 1st, 2019 for the 3 year old class and 4 years old by December 31st, 2019 for the 4 year old class. Classes are filled on a first come first serve basis We will try our best to accommodate your preference.
ENROLLEMENT INFORMATION
Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Physical Address (Street or Legal Land Description) *
Physical Address (Street or Legal Land Description)
Mailing Address *
Mailing Address
PRIMARY CONTACT INFORMATION
Does the child live with the primary contact? *
Primary Contacts Name *
Primary Contacts Name
Primary Number *
Primary Number
Secondary Number *
Secondary Number
Physical Address *
Physical Address
Place of Employment
Place of Employment
Work Number
Work Number
SECONDARY CONTACTS NAME
Secondary Contacts Full Name
Secondary Contacts Full Name
Primary Number
Primary Number
Physical Address
Physical Address
Place of Employment
Place of Employment
Work Number
Work Number
ADDITIONAL INFORMATION
IMMUNIZATIONS UP TO DATE? *
If NO, please be aware that Carstairs Playschool is not liable if your child comes in contact with any vaccinated diseases.
DRUG ALLERGIES? *
FOOD ALLERGIES? *
IS YOUR CHILD TAKING ON-GOING MEDICATIONS? *
EMERGENCY CONTACTS
Primary contact must be someone other the the primary or secondary contact. Emergency contacts must reside within one hour’s distance.
Emergency Contact 1 *
Emergency Contact 1
Primary Number *
Primary Number
Physical Address *
Physical Address
Emergency Contact 2 *
Emergency Contact 2
Primary Phone Number *
Primary Phone Number
Secondary Number
Secondary Number
Physical Address *
Physical Address
Emergency Contact 3 *
Emergency Contact 3
Primary Number *
Primary Number
Secondary Number
Secondary Number
Physical Address *
Physical Address
INDIVIDUALS AUTHORIZED TO SIGN YOUR CHILD IN & OUT OF PLAYSCHOOL
Name
Name
Name
Name
Name
Name
WAIVERS
In order to withdraw from the program, thirty days written notice must be provided. Tuition will be refunded for months following the thirty day period. If there are unforeseen circumstances surrounding the departure, it will be the Board’s discretion on the amount of tuition refunded. *
I hereby waive and release all rights and claims for damages that I may have against the Carstairs Playschool Society for any injuries sustained by my child at any time or activity under the jurisdiction of the above stated society. I also give the Carstairs Playschool personnel permission to perform first aid treatment or call 9-1-1 if necessary. *
Throughout the year, Carstairs Playschool students participate in off premise activities, which could include, but not limited to, short walks, playing at nearby parks in town, or exploring our neighborhood. All locations are within walking distance and children are never transported in motor vehicles. Your authorization is required for your child to attend these activities in the 2019/2020 school year.
I hereby consent and agree that Carstairs Playschool Society has the right to take or use photographs of my child to be used in the classroom, for student portfolios, in newspapers or other media for the purpose of publicity or advertisement.