Circle Drive Preschool – 2020/21 Application FormChildren RequirementsChild needs to be 3 years old before August 31. Children must be completely toilet trained and bathroom independent. No Pull-Ups.How did you hear about Circle Drive Preschool?*Student NameStudent First Name*Student Last Name*Called by nameReturning Student*YesNoBirthdate* Date Format: MM slash DD slash YYYY Your child needs to be 3 years old before August 31 to be old enough to participate in Circle Drive Preschool.Class SelectionPS1: Mon/Wed/Alternate Fri 9:00am - 11:30am $130.00 per month PS2: Mon/Wed/Alternate Fri 12:45pm - 3:15pm $130.00 per month PS3: Tues/Thurs morninig 9:00am - 11:30am $115.00 per month PS4: Tues/Thurs afternoon 12:45pm - 3:15pm $115.00 per monthFirst Choice*First Choice of ClassPS1PS2PS3PS4Second Choice*Second Choice of ClassPS1PS2PS3PS4Third Choice*Third Choice of ClassPS1PS2PS3PS4Student's Primary Residence InformationGender*FemaleMaleFirst Language*Second LanguageChurch Home*CircleNoneHome Address*City*SaskatoonMartensvilleWarmanPostal Code*Cell Phone*Email* Student Resides With*Two parentsMotherFatherJoint CustodyRelativeGuardianParent/Guardian Contact InformationFirst Name - Parent/Guardian 1*Last Name - Parent/Guardian 1*Relationship to Child - Parent/Guardian 1*Cell Phone - Parent/Guardian 1*First Name - Parent/Guardian 2Last Name - Parent/Guardian 2Relationship to Child - Parent/Guardian 2Cell Phone - Parent/Guardian 2Emergency Contact InformationFirst Name - Emergency Contact 1*Last Name - Emergency Contact 1*Relationship to Child - Emergency Contact 1*Cell Phone - Emergency Contact 1*First Name - Emergency Contact 2Last Name - Emergency Contact 2Relationship to Child - Emergency Contact 2Cell Phone - Emergency Contact 2Pre-authorized Pick UpIn addition to the above names, I give permission to release my child to the following people at class dismissal time. (i.e. friend, other preschool parent)First Name - Pre-authorized Pick Up 1*Last Name - Pre-authorized Pick Up 1*Relationship to Child - Pre-authorized Pick Up 1*Cell Phone - Pre-authorized Pick Up 1*First Name - Pre-authorized Pick Up 2Last Name - Pre-authorized Pick Up 2Relationship to Child - Pre-authorized Pick Up 2Cell Phone - Pre-authorized Pick Up 2Contact Information*This list of contacts will remain in effect until I provide email or written notice to Circle Drive Preschool of any changes to the individuals or their contact information. I will give email notice if these contacts change.Medical InformationStudent's Health Card Number*Doctor's NameDoctor's PhoneAllergies*Mark all that apply. Seasonal Food Insect Bites Requires an Epi Pen NoneMedical ConditionsEach child's abilities are assessed individually, and with respect to the classroom as a whole. Please disclose any special needs or educational assistant requirements during the application process, so that we may contact you for more information. Application approval is at the discretion of the Preschool Staff. Failure to fully disclose all relevant information on this application form will require a conversation with parents to discuss the viability of the child’s participation in the preschool.Medical Conditions:*Mark all that apply. ADD ADHD FAS Autism Anxiety Disorder Sees a Psychologist Speech or Language Delays NonePlease provide any additional information regarding special needs of which we should be aware:AuthorizationsInformation Release*The information provided in the registration package is confidential. In order to facilitate contacting other parents and new friends to arrange play dates or birthday party invitations, a class list will be distributed to all parents. Thus we request consent in preparation of such a list. Please choose one option below to indicate whether you wish to be included in such a list.I consent to the release of child's name, phone number and parent's name and email solely for the purpose of preparing a class phone list to be distributed to other members of the preschoolI do not want to have my information included on the class listField Trips/Outdoor Excursions/Volunteer Supervision Authorization*Circle Drive Preschool strives to enhance a child’s development by means of exploration. We intend to provide children with fun filled field trips and outdoor excursions. Please indicate whether or not you give permission for your child to participate in any field trips and/or outdoor excursions held during the preschool year. This means you understand that if transportation is required, it will be provided by you or by bus. This also means you understand that volunteers will be assisting with supervision.I give permission for my child to participate in any field trips and/or outdoor excursions.I do not give permission and will make separate arrangements for my child on the day of field tripsMedia Release*Circle Drive Preschool documents school events through the use of photos/videos. We will post photos/videos of school activities from time to time on the Preschool Facebook page and/or website. No names of children will be used. It is understood that Circle Drive Preschool has the right to take and post group activity photos/videos. Please indicate whether or not we are able to use your child’s individual photo/video on our website/Facebook page or not.I consent to the release of my child's individual photoI do not consent to the release of my child's individual photoConfirmation of EnrollmentOnce your enrollment is confirmed, you will receive an email with instructions regarding payment. In addition to your monthly tuition there is a one time $50 field trip fee and a one time $50 non-refundable registration fee.In late spring, you will be invited to attend our Preschool Sneak Peek. There, you and your preschooler will have the opportunity to tour the facility, and meet the staff. You will also receive all the information for the new school year including a copy of the Circle Drive Preschool Handbook, the school calendar and the staggered start dates for September.Withdrawal of Enrollment TermsWe require one FULL MONTH'S written notice when withdrawing from preschool. Please email email@example.comFees for one month will be forfeited if insufficient notice is given.Full refunds will only be issued if Circle Drive Preschool deems it necessary to cancel a class.If for any reason (medical, vacation or other) your child is unable to attend their preschool class(es), refunds will not be issued for time missed.With the interest of each child as our utmost concern, Circle Drive Preschool reserves the right to request the withdrawal of a child whom we feel is not ready for our preschool program. Any remaining tuition will be refunded, along with any unused portion of the field trip fee, less the $50.00 non-refundable registration fee.Terms of Agreement*The parent/guardian will assume full responsibility for their child’s safety on their way to and from preschool. This includes accompanying the child to their locker and supervising them until Preschool begins. Children must be picked up promptly after each class. The parent/guardian gives consent for their child to receive any medical care deemed necessary in the event of an emergency. It is understood that caution will be taken by the person(s) in charge to prevent injury, but neither those in charge, the preschool, nor the church will be held responsible in case of an accident.If a child is ill, the parent/guardian will not send the child to preschool. Any communicable diseases will be reported to the teacher immediately. All children must be toilet trained and washroom independent. No Pull Ups will be allowed.I have read and agree to the withdrawal of enrollment terms. I agree to the Terms of AgreementName First Last Relationship to Child*ParentGuardianConsent*I accept the above cited terms of agreement and wish to enroll my child, under these conditions, in Circle Drive Preschool. I have read and understand the tuition, fees and terms of Circle Drive Preschool. I will notify the Preschool of any changes to the information on this form. Signed ConsentPhoneThis field is for validation purposes and should be left unchanged.