Honeybee Play School: Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

2023-2024 School Year

Child’s Name *

Nickname or Preferred Name if different

Age *

Birth date *

YYYY

Address *

Parent's Name *

Parent’s Name

Cell Phone *

Home Phone

Work Phone

Email *

Emergency Contact on Vashon (who is allowed to pick up my child) *

Emergency Phone Numbers *

Out of State Emergency Contact *

Out of State Emergency Contact Phone Number *

Physician’s Name *

Physician's Phone *

Allergies, special dietary or medical concerns *

Medications taken by child *

My Child is current on vaccinnations *

Yes

Other:

In the event of a medical emergency, I give my permission for the paramedics with Vashon Fire Department to provide medical examination and any treatment necessary for my child in my absence. *

Please type your name as your digital signature of agreement.

In the event of a natural disaster or emergency, if I am unable to pick up my child from school, the following people are authorized to pick him/her up in my absence. (Please list at least 3 adults who are local) *

Tuition is $300 per month. The first month tuition is non-refundable and due March 1, 2023. Please text to coordinate drop off of a check, my number is 206-650-2594. *

Please type your name as your digital signature of agreement.

If my circumstances change during the school year I will give two weeks notice before withdrawing my child.

Please type your name as your digital signature of agreement.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms