2019 Registration | Foundations Early Learning and Family Center

Registration for: *

Child's Name *

First

Last

Nickname/name he or she should learn to write:

Birthdate *//

Child's Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Father's Name

First

Last

Mother's Name

First

Last

Legal Guardian (if other than mother/father):

First

Last

Address of Parent/Guardian if different from child's

Address Line 1

Address Line 2

City

State

Zip Code

Child lives with:

Are you currently: *

Married
Single
Separated
Divorced

Who will normally drop off your child? *

Who will normally pick up your child? *

Below, please list everyone who currently lives in your child’s household, including siblings, grandparents, step-parents, family friends, etc.:

Additional sibling(s) NOT living in the home:

Does your child currently have an Individual Education Plan (IEP)? *

Yes
No

Church Home:

Do you and your family attend church regularly?

Yes
No

School/Child Care Center Last Attended:

What are some of your child’s favorite activities?:

Activities your family enjoys together:

What is your child’s favorite color?

What is your child’s favorite animal?

Please list any additional information that you feel would be helpful for the teachers to know about your child (favorite books, special toys, fears, etc.).

Do you have any special talents or interests that you would be willing to share with your child’s class?

What do you hope your child will accomplish this year at Foundations?

How did you hear about Foundations?

Contact Information

Mother's Employer

Mother's Employer's Phone

Father's Employer

Father's Employer's Phone

List other telephone numbers such as beepers, cell phones etc

Instructions regarding how parent/guardian may be reached in an emergency

Child's Doctor's Name

First

Last

Doctor's Address

Address Line 1

Address Line 2

City

State

Zip Code

Doctor's Phone

Emergency Contacts

Contact One Name

First

Last

Contact One Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact One Phone

Contact Two Name

First

Last

Contact Two Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Two Phone

Contact Three Name

First

Last

Contact Three Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Three Phone

I give permission for my child to participate in:

Activities away from the facility

Yes
No

Transportation provided by the facility

Yes
No

Swimming/wading activities provided by the facility

Yes
No

Authorized Pick-Up Form

Parent/Guardian #1

Name

First

Last

Relationship to Child

Phone-Home

Phone-Work

Phone-Cell

Home Email *

Work Email

Do you receive text messages?

Yes
No

Best Method of contact

phone call
text
e-mail

Parent/Guardian #2

Name

First

Last

Relationship to Child

Phone-Home

Phone-Work

Phone-Cell

Home Email

Work Email

Do you receive text messages?

Yes
No

Best Method of contact

phone call
text
e-mail

Additional Persons Authorized ro pick up child:

Person 1 Name

First

Last

Relationship to Child

Phone-Home

Phone-Work

Phone-Cell

Best Method of contact

phone call
text
e-mail

Person #2 Name

First

Last

Relationship to Child

Phone-Home

Phone-Work

Phone-Cell

Best Method of contact

phone call
text
e-mail

Person #3 Name

First

Last

Relationship to Child

Phone-Home

Phone-Work

Phone-Cell

Best Method of contact

phone call
text
e-mail

I commit to keeping communication open and honest between my family and my child’s teachers and administrators *

Yes
No

I commit to paying my child’s tuition on time. *

Yes
No

I commit to attending required parent/teacher conferences (2 per school year) to receive necessary updates about my child’s progress. *

Yes
No

I commit to attending required Parent Involvement Meetings throughout the school year, making a positive effort to be mentally present and focused on both my child and my family’s development and growth, spiritually, physically, academically, and socially *

Yes
No

I commit to expressing concerns or questions that I may have to my child’s teacher first, and then, if necessary, to the administrator. *

Yes
No

I commit to praying for my child and his/her class as they grow and develop throughout the year. *

Yes
No

I agree to the Financial Policy *

Yes
No

Does your child have any known allergies? If so, please list and describe symptoms/reactions and if your child uses an Epi-pen.

Does your child have a history of: (Please check all that apply.)?

Other medical issues:

Please explain items checked (i.e. “wears glasses” or “tubes in ears” or “uses an inhaler”)

What is your child’s typical bedtime? *

Rising Time? *

PHOTO & VIDEO CONSENT

I give permission for my child’s image to be published *

Yes
No

I give permission for my child’s first and last name to be published *

Yes
No

I give permission for my child’s first name to be published *

Yes
No

I give permission for my child’s class work to be published *

Yes
No

I, as a parent/guardian, give permission for my child to attend any field trips taken by Foundations Early Learning and Family Center. I will not hold Foundations ELFC or any supporters of this program liable or responsible for any injuries, accidents, or mishaps that could be associated with each trip. 3-K Students are not allowed to ride the bus, but can attend any event if the parent or guardian transport them and attend the event. *

Yes
No

Do you agree to the Adult Conduct Policy? *

Yes
No

Contact Information

Emergency Contacts

I give permission for my child to participate in:

Authorized Pick-Up Form

Parent/Guardian #1

Parent/Guardian #2

Additional Persons Authorized ro pick up child:

PHOTO & VIDEO CONSENT

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