<p> St. Michael Preschool Registration Fee Paid (919)468-6110 ______</p><p>REGISTRATION FORM 2015/2016</p><p>Date: ______</p><p>Child’s full name______Birthdate______</p><p>Name or nickname teacher should use for child ______Sex ______</p><p>Student Ethnicity: (circle one) Black Hispanic Asian/Pacific Island American Indian White Multi Racial This information required for Diocesan Data Bank reporting purposes.</p><p>Address______City______State______Zip______</p><p>Home Telephone______Email Address______(Please print)</p><p>Father’s name______Occupation______</p><p>Employer______Telephone______Cell Phone______</p><p>Mother’s name______Occupation______</p><p>Employer ______Telephone ______Cell Phone ______</p><p>Siblings enrolled at St. Michael School ______</p><p>Siblings enrolled at St. Michael Preschool______</p><p>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. ______</p><p>Please indicate your preference for placement.</p><p>______2 years old by 8/31/2015, 2 days a week, M/W or T/TH (circle one) </p><p>______3 years old by 8/31/2015, 2 days, T/TH </p><p>______3 years old by 8/31/2015, 3 days, M/W/F</p><p>______4 years old by 8/31/2015, 3 days, M/W/F</p><p>______4 years old by 8/31/2015, 4 days, M-TH</p><p>______4 years old by 8/31/2015, 5 days M-F</p><p>______5 years old by 10/31/2015, Developmental Kindergarten, M-F</p><p>Are you interested in early morning drop-off at 8:15 a.m.? ______The cost will be $6 per day.</p><p>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 ______</p><p>Has your child attended another preschool or day care center? ______If so, where? ______</p><p>Are you aware of any special needs your child may have? ______Have these been evaluated? ______If yes, who did the evaluation? ______</p><p>Does your family speak a language other than English at home? ______If so, what is your child’s primary language? ______</p><p>Is there anything else about your child we should know that will be helpful (personality traits, allergies, asthma, or other medical concerns)? ______</p><p>______</p><p>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.</p><p>Signature______Date: ______</p><p>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.</p><p>Signature______</p><p>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.</p><p>(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.</p>