22-23 Preschool Registration
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Email *
Student First Name *
Student's Last Name *
Date of Birth *
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/
DD
/
YYYY
Street Address *
City *
Zip Code *
Parent/Guardian Information
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Parent/Guardian Additional Phone Number
Emergency Contact Information
(Other than above parent contact)

 I give permission for the following people to pick up my child from school.
#1 Emergency Contact (First Name) *
#1 Emergency Contact (Last Name) *
#1 Emergency Contact (Phone Number) *
#1 Emergency Contact
Additional Phone Number
#2 Emergency Contact *
First Name
#2 Emergency Contact *
Last Name
#2 Emergency Contact *
Phone Number
#2 Emergency Contact
Additional Phone Number
Additional Person who can pick up your child?
Additional Person who can pick up your child?
Does your child have any known allergies? *
If yes, please provide emergency treatment instructions
Does your child have any special physical or mental needs? *
If yes, please contact the Coordinator regarding these needs.
Do you or a family member work for Summit Academy? If Yes, Which campus and Name of the Employee. *
Does this student have a sibling attending? *
Required
Where did you hear about Summit Academy Preschool/Enrichment? *
Preschool Class Options
Preschool Options:

3 Year old's (Draper, Independence and Bluffdale) AM CLASSES ONLY

8:30AM-11:30AM

Monday, Wednesday and Friday $195.00 Per month

Tuesday and Thursday $140.00 Per Month

 

 

4 Year Old's (Draper, Independence and Bluffdale)

AM Class 8:30AM-11:30AM

PM Class 12:10PM-3:10PM

Monday, Wednesday, Friday $195.00 AM Class (MWF)

Monday, Wednesday and Thursday $195.00 PM CLASS (MWR)

Tuesday and Thursday $140.00 Per Month, AM Class

**NEW CLASSES**
4 Day Afternoon Preschool @ Bluffdale, Independence and Draper
Monday-Thursday
12:10-3:10PM
$240 Month
Class Options *
Required
Agreement
I,  acknowledge that I have read the Preschool Handbook and are aware of the policies and procedures at Summit Academy Preschool.

Those policies include the following important highlights:

Children will not be allowed to leave the school with any person that is not on the emergency

contact list or who does not have a visor card provided by the school.

Snacks will be provided daily by the preschool staff and the parents are responsible to

disclose any food allergies or dietary needs to the Preschool Director and/or the child’s

teachers.

Teachers are not permitted to help any child in the restroom other than buttoning and zipping

pants out in the hallway. If there is a need for adult help, the parents will be called.

Students may be picked up in the loading area from 11:30-11:40 for AM classes and 3:10-

3:20 for PM classes. If a parent arrives after the outlined times, students may be picked up at:

Draper in the gym (AM) in the office (PM), Bluffdale in the office, Independence in the

classroom. Parents will be charged $1 per minute after time indicated above. This

amount will be put on the following month’s bill.

Each monthly payment is due between the first (1st) and tenth (10th) of each month. Checks

should be payable to Summit Academy Preschool. A $25 late fee will applied after

the fifteenth (15th) of the month.  Tuition that is not paid by the 25th of the month will result in a DO NOT ATTEND.

Failure to pay tuition as scheduled may result in your student losing his/her place at the

preschool.

To withdraw your student, a 30 day written notice must be given to the Preschool Director.

Parents must provide current immunization records to the preschool and have turned in

signed consent/release and agreement forms before the student begins attending class.

For the safety of everyone involved, drivers must become familiar with the loading/unloading

procedure and may not get out of the car at any time while in the loading lane. Drivers

must pull over to the left if a child needs help buckling. Teachers are not permitted to buckle

students into the vehicle.

Summit Academy Preschool has the right to decline continued enrollment to any student who

is, or has parents that are, uncooperative or are abusive to school administrators, staff, or

other students. Abuse includes, but is not limited to, biting, kicking, spitting, and verbal

abuse.
Agreement *
Required
Media Consent
Student Media Consent and Release Form Throughout the school year, students may be highlighted in efforts to celebrate their achievements and promote Summit Academy activities, programs and achievements. This includes internal and external media such as social media, district’s website and other media platforms. Please complete this form and have your child return it to his or her school. This consent form remains valid throughout your child’s K-12 experience with Summit Academy Schools or until a new form is completed and signed by a parent / guardian or eligible student. I, _________________________________________________ as the parent or guardian of ___________________________________________________, grant permission to Summit Academy and its School Board, agents, employees and/or school staff to photograph my child and to record voice, performance, poses, acts, plays and appearances. I further grant my child’s school all rights to use these sounds, still, and moving images and other reproductions of physical likeness in any medium (i.e. print, website, video, social media). I understand that neither Summit Academy nor its representatives will reproduce said photographs, interviews or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photographs or likeness. I am also fully aware that I will not receive monetary compensation for my child’s participation. I further release and relieve Summit Academy, its School Board, employees and other representatives from any liabilities, known or unknown, arising from the use of this material. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing to the Summit Academy Student Media Consent and Release Form. I agree that my failure to raise any questions in writing in conjunction with the signing of this document will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Media Consent *
Consent, Waiver and Release of Liability
I hereby consent to allow my child to attend Summit Academy Preschool and participate in all activities sponsored by Summit Academy Preschool. I have inspected the premises and consulted with Summit Academy Preschool employees including teachers and instructors. I have determined that the premises are safe and I consent to leave my child in the care and custody of Summit Academy Employees. I represent that my child is properly immunized against all childhood diseases or illnesses. I represent that I have advised Summit Academy Preschool staff regarding any allergies or physical disabilities that my child may have. I agree to indemnify and hold Summit Academy Preschool its directors, employees and agents harmless against any and all claims arising from injury or illness my child may suffer as the result of food allergies or disabilities. I represent that my child has health insurance coverage and I agree that I will maintain said coverage during the entire time my child attends or participates at Summit Academy Preschool. I have been advised that Summit Academy Preschool does not provide health insurance or medical coverage to my child in any form under any circumstances. I agree to indemnify and hold Summit Academy Preschool its directors, employees and agents harmless against any and all claims arising as a result of my child attending and/or participating in the activities of Summit Academy Preschool. I authorize Summit Academy Preschool and its directors, employees and agents to provide first aid care, or emergency medical care to my child and/or to obtain such emergency medical care for my child as may appear reasonably necessary in my absence including emergency transportation to a hospital. I agree to be financially responsible for any and all medical expenses or costs that are incurred in treating my child for illness or injury when said illness or injury arises as while my child is on the premises of or in the custody of Summit Academy Preschool. .I CERTIFY THAT I HAVE READ THE ABOVE AGREEMENT AND AGREE TO THE TERMS THEREOF.
Consent, Waiver and Release of Liability *
Required
Parent/Guardian Name who is responsible for signing this agreement and completing registration. *
First Day Of Preschool and Preschool Assessments
Preschool Assessments: August 16-17, 2022
(No Classes this week, sign up dates will be emailed in August)
 
First Day of School:
August 22, 2022
(Monday, Wednesday, and Friday Class: MORNING CLASS)
 
August 22, 2022
(Monday, Wednesday, and Thursday Class: AFTERNOON CLASS)
 
August 22, 2022
(Monday-Thursday AFTERNOON CLASS)
 
August 23, 2022
(Tuesday and Thursday Class)
 
Preschool Open houses for the 22-23 School year will be in August, look for an email this summer with dates and more information.
 

Registration is not complete until the $75.00 registration fee has been paid.
Please refer to the preschool.summitacademyschools.org website for a link to make an online payment.
You will find the link under the "Info" Tab.
A copy of your responses will be emailed to the address you provided.
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