PLEASE READ ME

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General Information about the Child

Please select a class:

Please select a class:

Please select a class:

Does the child have any siblings? If so, how old?

Name Age Grade in School

Has child attended Calvary Preschool?:

YesNo

Parent/Guardian Information

Primary Contact (This form will be e-mailed to this person automatically for your records)

Secondary Contact

Help Us Get to Know Your Child Better

Has your child participated in any of the following programs?:

Emergency Contact Information

Please list your emergency contacts and persons authorized to pick up your child (other than the caregivers listed above).

Emergency Contact #1

Emergency Contact #2

Local Contact Information

Please list local persons to be contacted in case of an emergency (other than parents).

Local Contact #1

Local Contact #2

Healthcare Provider Contact Information

Child's Physician

Preferred Hospital

Child's Dentist

Permissions

I hereby grant permissions for my child to:

1. Use all of the play equipment and participate in all of the activities of the school.

2. Leave the school premises, under the supervision of staff members, for a neighborhood walk or for field trips.

I hereby grant permission for the Director or Acting Director to take what steps may be necessary to obtain emergency medical care if warranted. These steps may include, but are not limited to, the following:

1. Attempt to contact a parent or guardian.

2. Attempt to contact the child's physician.

3. Attempt to contact you through any of the persons listed on the child's emergency information form.

4. If we cannot contact you or your child's physician, we will do any or all of the following:

(a) call another physician or paramedics

(b) call an ambulance

(c) have the child taken to an emergency hospital in the company of a staff member.

5. Any expenses incurred under #4, above, will be borne by the child's family, except where school insurance is applicable.

6. The school WILL NOT be responsible for anything that may happen as a result of false or incomplete information given at the time of enrollment, or failure to keep that information current.