Application

Child's Name __________________________________Date of birth ___________ Age _____ Sex _____
If he/she goes by a nickname to be used at school let me know here ______________________________
Father's Name ___________________________ Occupation ____________________________________
Mother's Name __________________________ Occupation ____________________________________
Home Address _________________________________________________________________________
Home Phone Number ____________________________

Requirements for participation in preschool:

1. Child must be at least 3 yrs old, on or before September 1.

2. Payment of $10.00, non-refundable registration fee, to hold your child's place in preschool. Payment of $40.00 tuition fee on the first school day of each month. A late fee will be accessed on the third school day, of $5.00. Please make all checks payable to Amy Esplin.

3. For your child's own protection please have all required immunizations and doctor checkup before he enters preschool. Cooperations in keeping your child home when signs of cold or other symptoms of illness are present.

4. You are responsible for the transportation to and from school. You must escort your child to the preschool entrance. Please do not simply drop them off and drive away.

5. Provide a box of Kleenex and a change of clothes when necessary.

6. Parents must provide insurance or adequate means to cover the child in case of accident, for their child.

___________________________________________
Parent Signature,
I agree to all the above statements.

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