Registration Form | welcomeschool

Welcome School Registration Form

Child's First Name

Child's Last Name

Is your child male or female.

Male

Female

Birthdate

Child's Nickname or Name preference

Father or guardian's work phone number

Father or guardian's work address

Father or guardian's first name

Father or guardian's last name

Street Address

City

Street Address Line 2

Region/State/Province

Postal / Zip code

Father or guardian's email

Father or guardian's phone

Father or guardian's employer

Mother or guardian's first name

Mother or guardian's last name

Street Address

City

Street Address Line 2

Region/State/Province

Postal / Zip code

Mother or guardian's phone number

Mother or guardian's email

Mother or guardian's employer

Mother or guardian's employer address

Mother or guardian's employer phone number

Emergency Contacts (Other than parents): We must have 3 on file. Thanks!

1) Emergency Contact first and last name.

Relationship to child

2) Emergency Contact first and last name.

Relationship to child

Phone

Can pick up the child

Yes

Phone

Can pick up the child

Yes

3) Emergency Contact first and last name.

Relationship to child

Phone

Can pick up the child

Yes

Siblings

Sibling 1: First and last name

Sibling 1 age

Sibling 2: First and last name

Sibling 3: First and last name

Sibling 2 age

Sibling 3 age

Medical Information

Please make sure a copy of your child's current immunization record is attached.

Any healh related issues we should be aware?

Any medications needed for your child?

If so, please get a form from the director and fill out special medication instructions.

Any allergies?

If so, please attach a sheet instructing WS staff on what procedures to take if your child comes in contact with...

Any activities the child should NOT engage in?

Your childs doctor?

Name of Doctor’s facility

Doctor/Facility Phone number

Permission to call Doctor in case of emergency:

Parent Signature

Select a date

Emergency Medical Treatment

I give Welcome School permission to seek any necessary medical treatment for my child(ren). Welcome School will make every possible attempt to reach me in the case of an emergency, but in the event that I cannot be reached, one of the emergency contacts will be notified. Parent signature:

Parent Signature

Select a date

Permission to Photograph

I give Welcome School permission to photograph/record and post my child(ren’s) images. I understand that my child(ren’s) images may be used on Facebook or the website for Welcome School, although their identities will remain confidential.

Parent Signature

Select a date

Tuition Agreement

I agree to pay the following tuition amounts and fees to Welcome School in accordance with center policies as listed in the Parent Handbook. Payments are due the first of the month. A late fee will be charged for tuition that is paid after the seventh of the month. I also agree to pay any additional late fees incurred to Welcome School in accordance with the policies stated in the Parent Handbook. If my account goes unpaid, Welcome School reserves the right to terminate enrollment and seek any methods of collection necessary.

Registration Fee (per child):

$75 (non-refundable) + 2.99% Convenience Fee

Tuition (per child):

2 day $130/month** $1,111 after discount
3 day $150/month** $1,283 after discount
5 day $240/month** $2,052 after discount

**5% discount if paid in full by September

Student first name

Student last name

Parent Signature

Select a date

Upload File

Select an item ($)

Registration Fee - $77.24

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