JOYFUL NOISE PRESCHOOL

Registration Form

For Center Use:

Date of Admission:

Age at Admission:

Child's Name:

Date of Birth:

Parent's Names

Father:	Mother:
Home Address:	Home Address:
Town:	Town:
Home Telephone:	Home Telephone:
Cell phone/pager:	Cell phone/pager:

Others in Family/Relationship

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Business Addresses

Mother - Name of Business:	Work Telephone:
Address:	Hours at work:
Father - Name of Business:	Work Telephone:
Address:	Hours at work:

IF PARENTS CAN NOT BE CONTACTED, NOTIFY:

Name:	Relationship:
Address:	Telephone No.:
Name:	Relationship:
Address:	Telephone No.:
Child’s Physician/Clinic:	Telephone No.:

1. In the event of illness or accident (when parents cannot be readily contacted) I authorize the calling on of a physician and/or the providing of other necessary medical services at my expense. I will have a copy of my child’s health records on file with the school by October 1, and up-date current health forms as needed throughout the year.

2. I will fulfill my financial obligations to the Joyful Noise Preschool and will pay my bills promptly by the 15^th of the preceding month with the exception of September’s payment, which will be due on or before May 15^th.

What would you like your child to gain from this experience?

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I would like to enroll my child in the following programs(s):
(Indicate choice)

Mon./Wed./Fri. A.M.

Tue./Thurs. A.M.