Returning Preschool Application Appl - Preschool - Part 1 How did you hear about Circle Drive Preschool?* Children Requirements Child needs to be 3 years old on or before August 31. Children must be completely toilet trained and bathroom independent. No Pull-Ups.Student NameStudent First Name* Student Last Name* Called by name Returning Student* Yes No Birthdate* MM slash DD slash YYYY Your child needs to be 3 years old on or before August 31 to be old enough to participate in Circle Drive Preschool. Gender* Female Male Class Selection PS1: Mon/Wed/Alternate Fri 9:00am - 11:30am $150.00 per month PS2: Mon/Wed/Alternate Fri 12:45pm - 3:15pm $150.00 per month PS3: Tues/Thurs morning 9:00am - 11:30am $130.00 per month PS4: Tues/Thurs afternoon 12:45pm - 3:15pm $130.00 per month First Choice*First Choice of ClassPS1PS2PS3PS4Second Choice*Second Choice of ClassPS1PS2PS3PS4Third Choice*Third Choice of ClassPS1PS2PS3PS4Student's Primary Residence Information First Language* Second Language Church Home* Circle None Home Address* City* Saskatoon Martensville Warman Postal Code* Cell Phone*Email* Student Resides With* Two parents Mother Father Joint Custody Guardian Parent/Guardian Contact Information First Name - Parent/Guardian 1* Last Name - Parent/Guardian 1* Relationship to Child - Parent/Guardian 1* Cell Phone - Parent/Guardian 1*First Name - Parent/Guardian 2 Last Name - Parent/Guardian 2 Relationship to Child - Parent/Guardian 2 Cell Phone - Parent/Guardian 2Medical Information Student's Health Card Number* Doctor's Name Doctor's PhoneAllergies*Mark all that apply. Seasonal Food Insect Bites Requires an Epi Pen None Medical Conditions Each child's abilities are assessed individually, and with respect to the classroom as a whole. Please disclose any special needs or educational assistant requirements during the application process, so that we may contact you for more information. Application approval is at the discretion of the Preschool Staff. Failure to fully disclose all relevant information on this application form will require a conversation with parents to discuss the viability of the child’s participation in the preschool. Medical Conditions:*Mark all that apply. ADD ADHD FAS Autism Anxiety Disorder Sees a Psychologist Speech or Language Delays None Please provide any additional information regarding special needs of which we should be aware:Confirmation of Enrollment Once your enrolment is confirmed, you will receive an email with instructions regarding payment. In addition to your monthly tuition there is a one time $50 non-refundable registration fee. Withdrawal of Enrollment Terms We require one FULL MONTH'S written notice when withdrawing from preschool. Please email firstname.lastname@example.org Fees for one month will be forfeited if insufficient notice is given. Full refunds will only be issued if Circle Drive Preschool deems it necessary to cancel a class. If for any reason (medical, vacation or other) your child is unable to attend their preschool class(es), refunds will not be issued for time missed. With the interest of each child as our utmost concern, Circle Drive Preschool reserves the right to request the withdrawal of a child whom we feel is not ready for our preschool program. Any remaining tuition will be refunded less the $50.00 non-refundable registration fee. Terms of Agreement* The parent/guardian will assume full responsibility for their child’s safety on their way to and from preschool. This includes accompanying the child to their locker and supervising them until Preschool begins. Children must be picked up promptly after each class. The parent/guardian gives consent for their child to receive any medical care deemed necessary in the event of an emergency. It is understood that caution will be taken by the person(s) in charge to prevent injury, but neither those in charge, the preschool, nor the church will be held responsible in case of an accident. If a child is ill, the parent/guardian will not send the child to preschool. Any communicable diseases will be reported to the teacher immediately. All children must be toilet trained and washroom independent. No Pull Ups will be allowed. I have read and agree to the withdrawal of enrollment terms. I agree to the Terms of AgreementRelationship to Child* Parent Guardian Name* First Last Consent*I accept the above cited terms of agreement and wish to enroll my child, under these conditions, in Circle Drive Preschool. I have read and understand the tuition, fees and terms of Circle Drive Preschool. I will notify the Preschool of any changes to the information on this form. Signed ConsentNameThis field is for validation purposes and should be left unchanged.