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2021-2022 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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* Indicates required question
Email
*
Your email
Email (best way to reach you)
*
Your answer
Parent/Guardian Name (Last name first. Example: Smith, Jane)
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Your answer
Second Parent/Guardian Name (Last name first. Example: Smith, John)
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Your answer
Child's Name (Last name first. Example: Smith, Jane)
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Your answer
Child's Gender
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Female
Male
Child's Birthday (Note: Please do not bring birthday handouts to preschool.)
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MM
/
DD
/
YYYY
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.
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3T: 12 3/4" chest 17" length
4T: 13 1/2" chest 18" length
First Parent Contact Phone Number
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Your answer
Secondary Parent Contact Phone Number
Your answer
Address (line 1)
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Your answer
Address (line 2)
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Your answer
City, State, Zip
*
Your answer
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)
Your answer
Person #2 (name, relationship, phone number)
Your answer
Person #3 (name, relationship, phone number)
Your answer
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
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Your answer
Emergency Contact # 2
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Your answer
Child's Physicians Name
*
Your answer
Child's Physician's Phone Number
*
Your answer
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. *
*
Your answer
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. *
*
I authorize
I do not authorize
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.
*
Your answer
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