Student’s Name______________________________________

Monday____Tuesday____Wednesday____Thursday____Friday____

(8:00-11:45 AM)

Monday____Tuesday____Wednesday____Thursday____Friday____

(1:00-4:45 PM)

*Registration Fee enclosed ($25) $______

*Supply Reimbursement Fee ($25) $______

*Registration Information was updated (for returning students) ______

Start Date______________________ End Date _______________________

CONSENT

I,_________________________________ have read and understand the policies and procedures included in the parent handbook and will act in accordance with them. I expect preschool staff to act in accordance with them as well.

*In the event of a medical emergency involving a call to 911 any costs are

the parent’s responsibility___________(initial)

*One-month notice must be given in order to receive a refund________(initial)

Guardian Signature__________________________ Date_____________

Teacher Signature_________________________ Date_____________