Enrollment for 2017-2018

Date of Enrollment ____/____/______

Where learning and fun come together.

Please complete the form below and send it with the $50.00
registration fee (non-refundable) to:

Sara Gray
534 W Crenshaw Way
Saratoga Springs, UT 84045
-OR-
Venmo Sara Gray @MissSara

This form and fee will register and hold your childs spot for the Lakeside Learners Preschool 2017-18
school year. More information will be sent to your home and email as the preschool starting date
approaches. Preschool will begin Tuesday, September 5, 2016. I cant wait! I have a lot of
great things planned!

CHILD
Full Name:__________________________________________________ Date of Birth:__________________ Sex: M F

Nickname: _________________________________________________ Home Phone: _(______)_______________________

Address: ______________________________________________________ City: _______________________ Zip: __________

PRIMARY CAREGIVERS
Mother or Guardian:__________________________________________ Email:______________________________________

Home Phone: (_____)________________ Cell Phone: (_____)______________ Work Phone: (_____)_______________

Father or Guardian: __________________________________________ Email:______________________________________

Home Phone: (_____)________________ Cell Phone: (_____)______________ Work Phone: (_____)_______________

Primary Caregivers Address (if different from above)

Address: ______________________________________________________ City: _______________________ Zip: _________

SESSION

Check One

3 year olds T/Th

(turned 3 by Sept. 1st) 9:30-11:30

4 year olds M/W/F

(turned 4 by Sept. 1st) 9:30-11:30

EMERGENCY CONTACTS (other than parent)

Name:____________________________________ Relationship:_______________________ Phone: (____)______________

Name:____________________________________ Relationship:_______________________ Phone: (____)______________

PICKUP AUTHORIZATION
Name of Child:____________________________________________________________________________________________

Please list all individuals who are authorized to pick up your child. If one of the the individuals below show up
they may be required to show photo I.D. and sign out with me before picking up a child.

1. Name:_____________________________________ Relationship:______________________ Phone: _________________

2. Name:_____________________________________ Relationship:______________________ Phone: _________________

3. Name:_____________________________________ Relationship:______________________ Phone: _________________

4. Name:_____________________________________ Relationship:______________________ Phone: _________________

HEALTH INFORMATION
YOU WILL NEED TO ATTACH A COPY OF YOUR CHILDS CURRENT IMMUNIZATION INFORMATION

Does your child have any known allergies or sensitivities to:

YES NO If yes, please list:

Medication

Food

Other
List any additional health information or special instructions we should be aware of:
____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

List any regular medications your child takes:________________________________________________________________

Name of Childs Primary Physician:_________________________________________ Phone:_________________________

SIGNATURE
In case of injury or sudden illness, ____________________
will be called first. I hereby give authority to any hospital
or doctor to render immediate aid as might be required
at the time for his/her health and safety. It is understood
by me that the expense of this service will be accepted
by me.
_____________________________________________________
(Parent / Legal Guardian Signature)
I give Lakeside Leaners Preschool permission to take
photos of my child while attending Lakeside Leaners
Preschool. Further, I give permission for Lakeside Leaners
Preschool to utilize these photos in their marketing efforts
including brochures, websites, or newsletters.
____________________________________________________
(Parent / Legal Guardian Signature)

I understand the payment policy that tuition is due the
1st class period of each month and is considered late if
not received by the 10th. late fees may apply.
____________________________________________________
(Parent / Legal Guardian Signature)
I have read the policies and procedures. I understand
and agree to abide by all policies and procedures.
____________________________________________________
(Parent / Legal Guardian Signature)
Policies and Procedures

Payment
Registration fee of $50.00 is due with registration papers and is non-refundable. This will hold a spot for your child
in the upcoming school year as well as cover the cost of supplies throughout the year.
Tuition is due the 1st class period of each month and will be considered late on the 10th. If payments are received
late a late fee may be applied. Tuition is $65.00 each month for the 3-yr. old class on T/Th and $85.00 each month
for the 4-yr. old class on M/W/F. Please make checks payable to Sara Gray. A receipt will be sent home. Refunds
will not be given for classes missed.

Pick-up and Drop-off

The drop-off window is from 9:25-9:30 and the pick-up window is from 11:30-11:40. If you arrive early for either
window please park and wait for the correct time. It is important that you drop--off and pick-up your child as close
to the scheduled times as possible. Please be respectful of my time as I will always try to be respectful of yours.

Safety
I will take every precaution to keep our school safe. Please talk to your child about our rules and reinforce them at
home. Lakeside Learners Preschool is not liable for any foreseeable or unforeseeable injuries and/or accidents.

Communication
In order to keep you well informed, I will send monthly calendars and notes home with your child, answer questions
by phone and email or speak personally with parents as you pick up your children. Please check your childs
backpack each day for correspondence.

Your Childs Health

Contagious disease, colds and the flu can be problems for preschool children. For the health of your child and other
students please keep you child home if he or she has had a fever within the last 24 hours, at the onset of a common
cold, if your child has diarrhea, or if your child has a productive cough (your child is coughing up a substance). In
the event that a child becomes ill at school, parents will be called immediately to come pick-up their child.

Potty Training
I will take children who are still working on potty training although I will not change dipers or be able to watch the
clock to ask the child if they need to use the bathroom.

Change of Clothing
Although children are potty trained there may still be accidents that happen at school. We would like to lessen the
impact of these accidents, and quickly return your child to the class by having parents provide one extra set of
clothes for each child, to be kept in their classroom. Please bring the following items: Shirt, Underwear, Pants, and
Socks, in a plastic bag or small storage container labeled with your childs first and last name.

Schedule
The first day of school will be September 5, 2017 and the last day of school will be May 18, 2018. A full year
schedule will be handed out at our open house in August. If you would like to see this schedule before than please
let me know and I can get you a copy to look over.

I reserve the right to refuse service to anybody. (For example, if a child becomes a danger to others, lack of
payment, etc.)