SonShine Kids Preschool Application 2011-2012

Child’s Full Name____________________ Nickname_________

Date of Birth_____________ Age______ Gender________

Address (Street/apt. #) _______________________________________

(City/state/zip)_____________________________________________

Mailing address (if different than above)

Address (Street/apt. #) _______________________________________

(City/state/zip)_____________________________________________

Home Phone ___________________ Email Address ________________

Mother’s Cell Phone _____________ Father’s Cell Phone ____________

Father ______________________ Work Phone ___________________

Mother _____________________ Work Phone ____________________

Has your child attended preschool before? ___ Where? _____________

Do you attend church? _____ Where? ___________________________

Tuition : 2 days per week: $85/month $20 Supply fee per semester

5 days per week: $130/month $40 Supply fee per semester

Please Indicate Your Choice:

Tuesday/Thursday 9:00 AM-12:00 PM____

Monday, Wednesday, Friday 9:00 AM-12:00 PM _______

Monday-Friday 9:00-12:00 PM ________

Was child full term?___ Birth weight ____________

Pediatrician’s Name Address Phone

Hospital of Preference _______________________________________________

Emergency Contact #2 ________________________________________________

Any surgeries? _____ If yes, please explain________________________

Any serious illnesses? If yes, please explain _______________________

Allergies to food or medications? _______________________________

Allergies to bees? ___________________________________________

Any illness such as asthma or epilepsy that would involve extra attention during playtime? ____________________________________

Does your child need an inhaler or an EpiPen? ________________

(Must obtain a written order from the doctor)

We will be taking pictures on a regular basis. There may be times when we would like to use your child’s picture on our website or in the local paper, or just posted in our hallways.

I, ______________________, give SonShine Kids Preschool permission to take photographs of my child, _______________________, and use them on their website for promotional purposes, in the local newspaper, or for use within the school.

I, ______________________, do not give SonsShine Kids Preschool permission to take photographs of my child, _______________________, and use them on their website for promotional purposes, in the local newspaper, or for use within the school.

It is very important that we have current information regarding color and model of all vehicles that may transport your child. We will not release your child to any person or vehicle not listed on your transportation form. There will be more information in our handbook explaining our drop-off/pick-up procedure.

Who will be primarily transporting your child to school?

____________________________________________________

Name Color/model