St. Michael Preschool Registration Fee Paid

St. Michael Preschool Registration Fee Paid (919)468-6110 ______

REGISTRATION FORM 2015/2016

Date: ______

Child’s full name______Birthdate______

Name or nickname teacher should use for child ______Sex ______

Student Ethnicity: (circle one) Black Hispanic Asian/Pacific Island American Indian White Multi Racial This information required for Diocesan Data Bank reporting purposes.

Address______City______State______Zip______

Home Telephone______Email Address______(Please print)

Father’s name______Occupation______

Employer______Telephone______Cell Phone______

Mother’s name______Occupation______

Employer ______Telephone ______Cell Phone ______

Siblings enrolled at St. Michael School ______

Siblings enrolled at St. Michael Preschool______

Siblings (names/ages) ______Is your child baptized catholic? ______Are you a registered member of St. Michael’s church? ______Have you applied for the stewardship rate of tuition for the upcoming school year? ______If no, please list other parish or church affiliation. ______

Please indicate your preference for placement.

______2 years old by 8/31/2015, 2 days a week, M/W or T/TH (circle one)

______3 years old by 8/31/2015, 2 days, T/TH

______3 years old by 8/31/2015, 3 days, M/W/F

______4 years old by 8/31/2015, 3 days, M/W/F

______4 years old by 8/31/2015, 4 days, M-TH

______4 years old by 8/31/2015, 5 days M-F

______5 years old by 10/31/2015, Developmental Kindergarten, M-F

Are you interested in early morning drop-off at 8:15 a.m.? ______The cost will be $6 per day.

Please indicate your method of tuition payment for the 2015-2016 school year: 1 payment in full______2 payments ______10 monthly payments due on the fifth of each month ______

Has your child attended another preschool or day care center? ______If so, where? ______

Are you aware of any special needs your child may have? ______Have these been evaluated? ______If yes, who did the evaluation? ______

Does your family speak a language other than English at home? ______If so, what is your child’s primary language? ______

Is there anything else about your child we should know that will be helpful (personality traits, allergies, asthma, or other medical concerns)? ______

______

Preschool Parent Handbook: Handbooks are now accessible on line through the St. Michael website. They can be accessed at www.stmichaelcary.org/preschool. I acknowledge that I have read the St. Michael Preschool handbook and have been informed of policies and procedures.

Signature______Date: ______

Photo Release : I hereby give permission for my son/daughter to be photographed at St. Michael Preschool. I realize that the photo may be published in the newspaper, a magazine, the St. Michael preschool website, or other publication. The Preschool will not use any child’s name attached to a photo.

Signature______

Good Faith: Children are accepted in good faith. However, it is sometimes necessary to remove a child from the program. The director reserves the right to dismiss any child, if, after a conference with the child’s parents, she determines that it is in the best interest of the child.

(Please initial______) Upon enrollment the $110 registration fee is non-refundable and must accompany this form. A copy of your child’s birth certificate is required at the time of registration.