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Application

This document is a registration and application form for Carousel Playschool. It collects information about the child such as name, birthdate, contact information for parents/guardians. It also details fees, responsibilities of parents which include volunteer hours, fundraising commitments and permission for field trips and medical care. Parents must sign agreeing to commitments for the school to operate successfully as a parent cooperative.

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carouselplayschool
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106 views

Application

This document is a registration and application form for Carousel Playschool. It collects information about the child such as name, birthdate, contact information for parents/guardians. It also details fees, responsibilities of parents which include volunteer hours, fundraising commitments and permission for field trips and medical care. Parents must sign agreeing to commitments for the school to operate successfully as a parent cooperative.

Uploaded by

carouselplayschool
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Admin only:

CAROUSEL PLAYSCHOOL Date: ___________

APPLICATION AND REGISTRATION FORM Check #_________

Childs Name _____________________________________Sex_____ Date of Birth____________

Name you wish child to be called________________________________Class 3/4 or 4/5 (circle one)

Street Address_____________________________________________________________________

City______________________ ZIP _________________ Home Phone ______________________

Mothers Name__________________________________Occupation_________________________
(or guardian)

Work Phone_________________ Cell Phone_____________email___________________________

Fathers Name___________________________________Occupation_________________________
(or guardian)

Work Phone_________________ Cell Phone_____________email___________________________

Siblings (name and age) _____________________________ _________________________

_____________________________ _________________________

Comments on childs development ____________________________________________________


(i.e. habits, other language, left handed)

Emergency Contacts (other than parents). These persons will be authorized to pick-up your child.

1. Name___________________________________________Relationship______________________
Primary Phone _________________________________Secondary Phone ______________________

2. Name___________________________________________Relationship______________________
Primary Phone _________________________________Secondary Phone ______________________

Authorization for Medical Care

I understand I will be notified in case of accident or illness to my child, and I will make arrangements
for medical care for my child with the physician of my choice. For emergency medical treatment of
my child, if I cannot be reached to make necessary arrangements, I hereby authorize Carousel
Playschool to contact:

Doctor_______________________________________________Phone________________________

Address_________________________________________Preferred Hospital____________________

Signature of parent/guardian______________________________Date__________________________

Continued on back..
Field Trip Permission

I give permission for my child, ________________________________________, to take part in field


trips scheduled throughout the school year. I understand that Carousel Playschool will not be held
liable for accidents and injury, which may occur during the course of these trips. I will be notified prior
to each trip by newsletter or note.

Signature of parent/guardian__________________________________Date_____________________

Fees and Responsibilities

A $50.00 non-refundable registration fee is required to confirm your childs registration.


For those on a waiting list a fee is only required when you are notified of an opening.

Monthly fees are due at the first of the month and are delinquent after the 10th. ($10 late fee)
3-4 year old class - $70.00/month 4-5 year old class $85.00/month

As a parent cooperative, the participation and cooperation of the parents are vital to Carousels
success. As part of your childs enrollment you are committed to the following:

Provide/Show: Application and enrollment fee


Child physical and proof of immunization (incl. Varicella/Chickenpox)
Parent helper(s) physical and TB test
Parent helper(s) drivers license and auto insurance
Parent helper(s) social security number (for state childcare background check)

Once a year commitment: Field trip driver


Saturday morning cleaning

Over the course of year: Serve on committee or board to maintain operation of the school
Pay fees on time (10th of each month)
Fundraising of $80.00 through Carousel events or individually
Parent help for required number of days
(including providing refreshments and set up/clean up)
Attendance at Fall Orientation
Participate in fall school set-up and end of year clean up

I understand and agree to these commitments as a member of Carousel Playschool.

Signature of parent/guardian________________________________Date_______________________
Please attach registration fee to this form and return to: Carousel Playschool
Attn: Vice President
2601 Broadway
Columbia, MO 65203

Agreements
A. I have been informed of the required health and safety inspections and that the inspection forms
are available for review.
B. When my child is ill, I understand and agree that my child may not be accepted for care.

Signature of parent/guardian________________________________Date_______________________

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