Sky Valley Preschool Academy Registration
2010-2011 School Year
Parent Authorization for Participation & Medical Releas Students Name:_____________________________________________________________________
Address:___________________________________________________________________________
City:______________________________________________________State:________Zip:________
Phone:____________________________________________________Cell:_____________________
Mothers Names:____________________________________________Phone:___________________
E-Mail_____________________________________________________Cell:_____________________
Fathers Name:____________________________________________
Phone:____________________
E-Mail_____________________________________________________Cell:_____________________
Emergency
Contact: _______________________________________Phone:____________________
Students Birth Date: ________________________________________Age:_____________________
Authorization for pick up:_____________________________________________________________
Allergies:___________________________________________________________________________
Doctors Name:_________________________________Phone________________________________
Medications:________________________________________________________________________ Registration Per Year: 2
½’s $50.00, 3 & 4’s & Pre - K $90.00 (circle one) Tuition
& Classes ( Circle One) ( All field trips are included in fees) 2 ½ year olds Mornings Tues & Thurs 8:30 - 10:30 & 10:00 -12:00 $130.00 per month
3 - 4 year olds Mornings Tues & Thurs 8:30 - 12:00 $170.00 per month
3 - 4 year olds Mornings Mon, Wed & Fri
8:30 - 12:00 $230.00 per month
3 - 4 year olds Afternoons Tues & Thurs 12:15 - 3:45 $170.00
per month
3 - 4 year olds Afternoons Mon, Wed & Fri 8:30 - 12:00 $230.00 per month
Pre K Mornings Mon, Wed & Fri 8:30 - 12:00 $230.00 per month
Pre
K Mornings Tues & Thurs 8:30 - 12:00 $170.00 per month
Pre K Afternoons Mon, Wed &
Fri 12:15 - 3:45 $230.00 per month
Pre K Afternoons Tues & Thurs 12:15 - 3:45 $170.00
per month 5 Days Mornings or 5 Day Afternoons $360.00,
2 Days All Day
$ 310.00 3 Days All Day $410.00 5 Days All Day $640.00 I
understand this form legally releases all obligations and responsibilities to Sky Valley Preschool
/ Gymnastics Academy/Staff
/ Teachers for the medical treatment of my daughter/son in the
event of illness or injury during school and/or school
related activity when either parent cannot
be reached. If there is any physical or medical reason why he/she should not
participate fully
at an Sky Valley Preschool Academy event requires a doctor’s release. I also release Sky Valley
Preschool Academy / Gymnastics Academy of any and all responsibility due to accident
or injury during any type
of activity during the school year. I acknowledge that my daughter/
son is enrolled in Sky Valley Preschool Academy and
will participate in all school activities.
I understand that each child must abide by the rules and regulations set
forth by the teachers
at Sky Valley Preschool Academy. I have read the rules and regulations and understand them
completely. I understand that a violation of any of these rules my lead to temporary or
permanent suspension from
the school. I must give a 30 day writen notice when discontinuing
classes. I am responsibile
for tuition from the date of notice to the end of the 30 days.
I give Sky
Valley Preschool Academy permission to post or use photos throughout the year on
flyers or bulletin boards. Yes__________No_________ Parent/Legal Guardian
Signature:_________________________________________________Date__________________
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