2022-23 Preschool Registration Form
Parents/Guardians must submit this form before your child will be considered for Camelot Kids Preschool
If you have multiple children to register, fill out the form for EACH child.  Thank you!
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Email *
NEW THIS YEAR!!! We will be providing preschool most weeks Monday, Tuesday, Thursday, and Friday.  We will not meet on the abbreviated day of the week (currently, this is Wednesday. Select which of the following sessions you need for your child: *
Child's First Name *
Child's Last Name *
Child's Gender *
Child's Birthday (Note: Please do not bring birthday handouts to preschool.) *
MM
/
DD
/
YYYY
Email (best way to reach you) *
Mother's First Name "Parent #1" *
Mother's Last Name *
Mother's Preferred Phone Number (format 888-555-5555) *
Father's First Name "Parent #2" *
Father's Last Name *
Father's Preferred Phone Number  (format 888-555-5555)
If parents are divorced, please list additional parent (not residing with child) in this space if you desire.  Include first and last name followed by their phone number. *
Address (line 1) For Example: 100 N. 200 S.  Apt. #3 *
City, State, Zip *
What size T-shirt for your child?                           Shirt Sizing: Body LENGTH at the back is measured from high point shoulder to finished hem at back. CHEST is measured across the chest one inch below armhole when laid flat. *
Who do you authorize to pick up your child if you are unable?   Please include name, relationship and home/cell number. (All must be listed)  For example: Jane Smith, Grandmother, 801-555-5555
Person #1 (name, relationship, phone number)
Person #2 (name, relationship, phone number)
Person #3 (name, relationship, phone number)
Emergency contact who may be called in case of illness or emergency if neither parent or guardian may be reached. Please include name, relationship and home/cell number.)
Emergency Contact #1  (Name, relationship, phone number) *
Emergency Contact # 2 (Name, relationship, phone number) *
Child's Physicians Name *
Child's Physician's Phone Number *
Does your child have any physical problems (seizures, asthma, diabetes, allergies, drug reactions, etc.?) If so, please describe and give instructions for the care of the above-mentioned problem. * *
In case of serious emergency or illness, when the parents cannot be reached immediately, I hereby authorize the childcare provider to obtain emergency medical care and to obtain or provide emergency medical transportation. *
Further, I understand that this preschool is a training program for students attending Lone Peak High School. I realize that the high school students will have experiences in teaching and caring for my child(ren) under the supervision of the adult coordinator, director and assistants. * *
By signing your electronic signature below you commit to let Mrs. Springer know as soon as possible (rspringer@alpinedistrict.org) if your plans change and you no longer desire to enroll your child in Camelot Kids Preschool for the 2020-2021 school year. We have a waiting list each year and, knowing who is no longer interested, helps us to enroll other interested children. Please sign below. *
A copy of your responses will be emailed to the address you provided.
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