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School Age after school program
Minimum of 3 days a week with a set schedule is required. Once enrollment form is completed reach out to me to confirm availability on requested schedule.
If you have questions or concerns please email me directly at
KatsClassroomYelm@gmail.com
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* Indicates required question
Email
*
Your email
Child's first and last name
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Your answer
Child's date of birth
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MM
/
DD
/
YYYY
Enrollment days requested - 3 day minimum
*This does not guarantee this schedule and availability. A paid invoice will secure your child's selected schedule.
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PM
Not attending
Monday
Tuesday
Wednesday
Thursday
Friday
PM
Not attending
Monday
Tuesday
Wednesday
Thursday
Friday
What elementary school does your child need transportation from?
*
Choose
Southworth Elementary
McKenna Elementary
Fort Stevens Elementary
Prairie Elementary
Mill Pond Elementary
Living arrangements
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Mother
Father
Both
Other:
Mother or caregiver name
*
Your answer
Mother or first caregiver contact number
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Your answer
Address
*
Your answer
Email Address
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Your answer
Employer and phone number
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Your answer
Father or caregiver name
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Your answer
Father or caregiver's phone number
*
Your answer
Address
*
Your answer
Email address
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Your answer
Employer and phone number
*
Your answer
Emergency Contact Name
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This person will be called in case of an emergency and parents can not be reached. This also authorizes them to pick up your child in your place.
Your answer
Relationship
*
Your answer
Phone number
*
Your answer
Emergency Contact Name
*
Your answer
Relationship
*
Your answer
Phone number
*
Your answer
Emergency Contact name
*
Your answer
Relationship
*
Your answer
Phone number
*
Your answer
Is there any special instructions for caring for your child?
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Yes
No
If yes, please explain
Does your child have a limitation that may require additional assistance to be successful in class?
*
Yes
No
If yes, please explain
Does your child have allergies? (seasonal, food, insects, etc)
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Yes
No
If yes, please explain in next response
If your child has a food allergy please explain what occurs if ingested.
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Your answer
Does your child have an EpiPen due to these allergies?
*
Yes
No
Child's doctor and contact phone number
*
yes, we are required by licensing to ask this question and have it on file.
Your answer
Video release allows us to use your child's photo for media related to the preschool on social media and print. These photos will not be sold, they are simply to share experiences with friends and family. If further clarification is needed let us know please.
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Yes
Please insure the information is as accurate as possible, please understand it is your responsibility to update this information in writing as it changes. Please type your name in agreement
*
Your answer
A copy of your responses will be emailed to the address you provided.
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